心肌梗死恢复期患者运动前后血清肌钙蛋白Ⅰ水平变化

Level of cardiac troponin Ⅰin patients with myocardial infarction in front and back on the sport

目的观察心肌梗死恢复期患者在症状限制性运动试验和运动训练期后心肌钙蛋白Ⅰ的变化。方法20例心肌梗死恢复期中度心力衰竭患者与15例轻度心力衰竭患者及10例无心力衰竭受试者进行对比观察，他们均进行了症状限制性运动试验和单期运动训练（达最大心率的80％以上，持续时间30min），分别测定其基础肌钙蛋白（CTNI）值、症状限制性试验后和运动训练后1～5h时的CTNI值。结果症状限制性运动试验后，中度心力衰竭患者CNTI值由（38±19）pg／ml增加到（75±29）pg／ml，其中5例中度心力衰竭患者和4例轻度心力衰竭患者的CNTI值升高到100pg／ml以上。无心力衰竭的受试者无论是静息时或是运动后其CNTI值均较低（P〈0．05）。结论心肌梗死恢复期中度心力衰竭患者在症状限制性运动试验后其CNTI值增加，其水平达到轻微的心肌损伤水平，这一现象对患者预后的影响值得进一步研究。

Objective To study whether an increase of cardiac troponin I（cTnI） can be observed after symptom - limited exercise and an exercise training session in patients with myocardial infarction（MI）. Methods Twenty cases of MI and moderate heart failure were compared with 15 patients with MI and mild heart failure and 10 normal subjects without heart failure. All subjects underwent a symptom - limited test and an exercise training session at 〉 80% of maximal heart rate over time 30 minutes. The plasma cTnI level were measured at baseline, after symptom - limited exercise hourly for 5 hours, and 1 to 5 hours after training. Results Patients with MI and moderate heart failure showed an increase of cTnI from （38 ± 19 ） pg/ml to （75 ± 29 ） pg/ml （ P 〈 0.01 ） after symptom - limited exercise. Five patients with moderate and two patients with mild heart failure and normal cTnI values at rest showed the increase of cTnI above 100 pg/ml after acute exercise but not after training. Subjects without heart failure had lower cTnI levels at rest and significantly lower values after symptom - limited exercise and training （ P 〈 0.05 for each）. Conclusion Patients with MI and symptomatic heart failure show an increase of cTnI after symptom - limited exercise at levels that indicate minor myocardial damage. The prognostic impact of this finding should be further investigated.