急性心肌梗死患者血清心肌肌钙蛋白T的释放特点及临床意义

The clinical significance of changes in serum cardiac troponin T in acute myocardial infarction

目的：为了解急性心肌梗死（ＡＭＩ）患者血清心肌肌钙蛋白Ｔ（ｃＴｎＴ）的释放特点及其临床意义。方法：采用酶联免疫方法对２４例ＡＭＩ患者进行动态血清ｃＴｎＴ测定。结果：①ＡＭＩ患者ｃＴｎＴ峰值显著升高。６例呈早期最大峰值双峰曲线，第１峰约在ＡＭＩ后１０小时～１６小时出现，第２峰较平坦，约在ＡＭＩ后７２小时～９６小时出现；第１峰值为（１５．３０±３．５０）μｇ／Ｌ，第２峰值为（６．６０±４．３０）μｇ／Ｌ；１４例呈后期最大峰值双峰曲线，第１峰约在ＡＭＩ后２４小时出现，第２峰约在ＡＭＩ后６０小时～９２小时出现，第２峰值〔（１１．３０±５．７０）μｇ／Ｌ〕明显高于第１峰值〔（５．６０±２．４０）μｇ／Ｌ〕。４例呈单峰曲线，其ｃＴｎＴ峰值〔（１３．９０±４．２０）μｇ／Ｌ〕在梗死后约７２小时出现。②最大ｃＴｎＴ浓度与最大肌酸激酶（ＣＫ）、肌酸激酶同功酶（ＣＫＭＢ）有相关性（ｒ值分别为０．７３和０．７８，Ｐ均＜０．００１）。③ｃＴｎＴ最早升高时间约在ＡＭＩ后３小时，可持续２周或更长时间。结论：检测血清ｃＴｎＴ对ＡＭＩ的早期诊断具有灵敏度高、特异性强的特点；ｃＴｎＴ呈早期最大峰值双峰曲线的变化与梗死后血清ｃＴｎＴ第１４小时?

Objective:To evaluate the clinical significance of changes in serum cardiac troponin T(cTnT) in patients with acute myocardial infarction (AMI).Methods:Serum cTnT levels were measured by enzymelinked immunosorbent assay in patients with AMI.Results:Serum cTnT concentrations increased significantly in AMI,and it showed a doublepeak curve in 6 patients.The first peak 〔(1530±350)μg/L〕 was the highest,appearing at 10 to 16 hours and the second peak 〔(660±430)μg/L〕 at 72 to 96 hours after AMI.In 14 patients cTnT concentrations showed a doublepeak curve with delayed highest peak,being at 24 hours and 60 to 92 hours after AMI,and cTnT concentrations of the second peak was markedly higher than that of the first peak 〔(1130±570)μg/L vs.(560±240)μg/L〕.In 4 patients,it showed only a single peak〔(1390±420)μg/L〕,being at about 72 hours following AMI.It was also found that the maximal serum cTnT concentration was correlated with the maximal serum creatine kinase (r=073,P<0001)and creatine kinase MB levels (r=078,P<0001).In addition,cTnT concentrations began to increase about 3 hours after AMI,and it sustained for 2 more weeks.Conclusions:It suggests that cTnT measurement in serum apears to be a method of high specificity and sensitivity for the early diagnosis of AMI,cTnT concentration curve has an important reference value to reperfusion by its doublepeak curve with early highest peak,and the ratio of serum cTnT concentration at 14 hours to that at 38 hours after AMI.