急性肺血栓栓塞患者血清心肌酶的变化

Changes of the serum myocardial enzymes in patients with acute pulmonary thromboembolism

目的比较急性大面积、次大面积、非大面积肺血栓栓塞症（PTE）患者治疗前与治疗后各时间段心肌酶的变化，及其与估测肺动脉压力、右心功能及预后的关系。方法519例PTE患者来自北京24家医院参与的国家“十五”科技攻关课题——肺栓塞规范化诊治方法的研究。根据2001年5月中华医学会呼吸病学分会制定的《肺血栓栓塞症的诊断与治疗指南（草案）》的诊断标准确定大面积、次大面积、非大面积肺栓塞患者。大面积、次大面积患者采用溶栓治疗，非大面积肺栓塞患者采用抗凝治疗。按中心随机方法将患者分组，应用尿激酶和重组组织型纤溶酶原激活剂及普通肝素和低分子肝素。结果（1）大面积VIE患者治疗前血清CPK、LDH水平明显高于次大面积、非大面积PTE患者（P〈0．01）；（2）3组间及各组治疗前、后血清CK-MB水平差异无统计学意义；（3）519例FTE患者45例估测肺动脉压≥80mmHg者，血清LDH升高24例（54．4％），P〈0．01；169例治疗前存在右心运动功能减弱者，血清LDH升高者68例（40．2％），P=0．049；48例预后不良者血清LDH升高者15例（30．8％），P=0．039。结论①急性PTE患者可出现血清CPK、LDH水平升高，不伴有血清CK-MB的异常。②血清LDH水平与患者估测肺动脉压力、右心功能及预后密切相关。

Objective To explore the changes of the serum cardiac enzymes in patients with acute massive pulmonary thromboembolism （PTE）, sub-massive PIE and non-massive PTE between pre-therapy and post-therapy and its relationship. Method The prospective muhi-centres trial included 519 patients with confirmed PTE from 24 joint hospitals in Beijing, consisting of 54 massive PTE, 195 sub-massive PTE and 270 non-massive PTE. Thrombolytic treatment was used in massive and sub-massive PTE patients with employment of urokinase and re- combinant tissue plasminogen activator （rt-PA）, and anti-coagulative therapy with unfractionated heparin and low molecular heparin was used in non-massive PTE. Results （1） The values of serum CPK and LDH in massive PTE patients before therapeutical intervention were obviously higher than those in sub-massive and non-massive PTE patients （ P 〈 0.01）; （2） Of 45 patients with high pulmonary pressure, 24（54.4%） patients had high serum LDH（ P 〈0.01）. Of 169 patients with right ventricular dysfunction,68（40.2%） ones has high serum LDH（ P =0.049）. of 48 patients suffered from poor prognosis, 15（30.8%） ones had high serum LDH（ P = 0.039）. Conclusions （1）The values of serum CPK and LDH in acute PIE patients increase without elevation of CK-MB. （2）Serum LDH associates with pulmonary presure, right ventricular function and prognosis.