肌钙蛋白T对缺血性心肌细胞损伤的诊断及其对溶栓疗效的判定价值

Serum Troponin T Level in the Diagnosis of Ischemic Myocardial Injury and in the Evaluation of Thrombolytic Effect in Acute Myocardial Infarction

目的：评价肌钙蛋白Ｔ（ＴｎＴ）血清浓度变化对缺血性心肌细胞损伤的诊断及其对溶栓疗效的判定价值。方法：采用酶联免疫吸附法测定１６１例急性心肌梗死及５７例心绞痛患者ＴｎＴ浓度动态变化。结果：急性心肌梗死发病后２、４、６小时ＴｎＴ的阳性率分别为５８．０％、６８．６％、９０．９％，１０小时至５天为１００．０％，７、１０、１４、１７、２１天分别为９１．７％、６６．７％、２２．０％、１２．１％、９．２％，明显高于血清肌酸激酶及血清肌酸激酶ＭＢ同工酶（Ｐ＜０．０１）。ＴｎＴ诊断急性心肌梗死的敏感性和特异性为１００．０％及９１．８％。溶栓再通组ＴｎＴ呈双峰性曲线，未通组呈单峰性曲线，其峰值时间（４２．０２±１．６５小时）早于双峰性曲线的晚期峰时间（７５．１０±１．３３小时，Ｐ＜０．０１），其浓度（１４．６２±１．９１μｇ／Ｌ）明显高于双峰性曲线的晚期峰值（７．０２±０．８５μｇ／Ｌ，Ｐ＜０．０１）。结论：ＴｎＴ是一灵敏度高、特异性强的心肌损伤性血清标志物，对急性心肌梗死溶栓有无再通有一定判定价值。

? Objective:To Evaluate the diagnostic value of the changes of serum troponin T(TnT) level in ischemic myocardial injury and its significance in identification of reperfusion after thrombolysis in acute myocardial(AMI). Methods:TnT level of 161 patients of AMI and 57 of angina pectoris were determined by ELISA. Results:TnT appeared in serum at 2,4,6 hours after AMI in 580%,686%,909% cases at 10 hours to 5 days in 1000%;and on the 7th,10th,14th,17th and 21st day in 917%,667%,220%,121% and 92%,respectively.They were apparently higher than creatine kinase(CK)and MB isoenzyme of creatine kinase(CKMB)(p<0.01).The sensitivity was 1000% and specificity 918%.The TnT appear in biphasic curve in 34 AMI patients with reperfusion.The early TnT peak was absent in the patient with nonreperfusion.The time to TnT peak (4202±165 h) was earlier and the peak concentration (1462±191 μg/L) was higher than the late peak of biphasic curve (7510±133 h,p<0.01) and (702±0.85 μg/L,p<0.01),respectively. Conclusion:Serum TnT appears to be a more sensitive and specific in dicator of myocardialcell injury and has certain predicive value for the effect of thrombolysis in AMI.