急性脑梗死患者动态心电图和肌钙蛋白改变研究

The study of dynamic electrocardiogram and troponin change in patient with acute cerebral infarction

目的探讨肌钙蛋白I(cTnI)改变与脑梗死、心肌缺血的关系;观察急性脑梗死患者心肌缺血(包括无症状心肌缺血)的发生率,为临床治疗提供依据。方法选择156例急性脑梗死患者,其中合并心肌缺血组103例(A组),无心肌缺血组53例(B组),患者均行颅脑CT和检测CTNI值并行动态心电图。结果 A组患者中无症状心肌缺血发生率高,尤其是合并糖尿病者(P<0.05);糖尿病与高低密度脂蛋白胆固醇(LDL-c)血症为脑梗死患者合并冠心病的独立危险因素。结论脑梗死合并冠心病发生率高,且无症状心肌缺血占比例较大。cTnI做为心肌损伤的特异敏感指标,在脑梗死时出现阳性提示存在心肌损伤。

Objective To investigate the relationship between troponin changes,and cerebral ischemia as well as myocardial ischemia by electrocardiogram examination,dynamic electrocardiogram（Holter）and detection of troponin I in patient with acute cerebral infarction,and to observe the incidence of myocardial ischemia of patients,including silent myocardial ischemia,in order to provide the basis for clinical treatment.Methods 156 patients with acute cerebral infarction were enrolled in the study,103 patients in group A who was complicated with myocardial ischemia and 53 patients in group B who was not complicated with myocardial ischemia.All the patients were examined by CT,Holter,and CTNI value was calculated.Results The incidence of relapsed,massive and multiple cerebral infarction in the group A was significantly higher than that of group B（P0.05）.Diabetes Mellitus and LDL-c were the independent risk factors of patients with cerebral infarction complicated coronary heart disease,and the incidence of silent myocardial ischemia was higher,SMI incidence of diabetes was significantly increased,as compared with non-diabetic patients（P0.05）.Conclusion The cerebral infarction combined with coronary heart disease is comparatively common,moreover,silent myocardial ischemia accounts for the large percentage.Troponin I as a special and sensitive index of myocardial damage can hint myocardial damage when the result is positive in patients with cerebral infarction.