肌钙蛋白Ⅰ与心肌酶对急性心肌梗死早期诊断及溶栓再通指标的对比研究

Troponin I and Myocardial Enzyme in Early Diagnosis of Acute Myocardial Infarction and Thrombolytic Recanalization Comparative Study of Indicators

目的:旨在观察急性心肌梗死(AMI)患者血清中心肌肌钙蛋白Ⅰ(cTnI)释放动力学,浓度曲线,峰值特点及与血清肌酸激酶(CK)及肌酸激酶同工酶(CK-MB)动态变化的比较,以确定cTnI早期诊断AMI及判断溶栓后再通的价值。方法:对102例AMI患者进行溶栓治疗前后血清cTnI的动态检测分析,并与CK、CK-MB做比较。结果:cTnI升高时间比CK、CK-MB早2h,AMI在起病后6h内,cTnI、CK、CK-MB检测的阳性率分别为100%、66%和64%,起病后6h内cTnI检测的阳性率显著高于CK、CK-MB(P<0.05):cTnI 增高持续时间长达7天以上,显著长于CK、CK-MB(P<0.01):cTnI峰值溶栓再通组明显提前为10～14h,比CK、CK-MB早2h左右,而溶栓失败组明显延长到26～29h,与CK、CK-MB组无区别。结论:cTnI是反映心肌细胞损伤敏感性高、特异性强的生化指标,动态观察cTnI的变化,对AMI早期或晚期的诊断及溶栓治疗后血管再通的判断有重要的临床价值。

Objective： To observe the acute myocardial infarction （AMI） in patients with cardiac troponin I （cTnI） release kinetics, the concentration curve, peak characteristics and serum creatine kinase （CK） and creatine kinase isoenzyme （CK-MB） Comparison of dynamic change in order to determine cTnl early diagnosis of AMl and to determine the value of thrombolytic therapy after pass. Methods： 102 patients with AMI before and after thrombolytic therapy in patients with serum cTnl analysis of the dynamic test and with the CK, CK-MB compared. Results：cTnI elevated longer than CK, CK-MB as early as 2h, AM1 within 6 h after the onset, cTnI, CK, CK-MB test positive rates were 100%, 66% and 64%, onset after 6 h, cTnI testing positive was significantly higher than CK, CK-MB （P〈0.05）; cTnI increased the duration of up to 7 days, significantly longer than CK, CK-MB （P〈0.01）; cTnl peak thrombolytic recanalization significantly in advance for 10-14h, compared with CK, CK-MB as early as 2h, while the failttre of thrombolytic therapy group was significantly extended to 26-29h, and CK, CK- MB was no difference. Conclusions：cTnl is a sensitive indicator of myocardial cell injury high specificity of biochemical indicators, dynamic observation of changes in cTnI for AMI diagnosis and early or late recanalization after thrombolytic therapy in judgments has important clinical value.