用心肌钙蛋白T判断急性心肌梗塞溶栓疗效的观察

Detection of cTnT for judgement of effect of thrombolytic therapy on acute AMI

目的动态观察急性心肌梗塞（AMI）患者溶栓治疗后肌酸激酶（CK），肌酸激酶MB同功酶（CK－MB）活性及心肌肌钙蛋白T（cTnT）浓度变化规律，探讨cTnT对判断冠脉再通的临床价值。方法选择AMI并接受溶栓治疗患者37例，将其分为再灌注组与未再灌注组，于溶栓前和发病后间隔一定时间分别采血。同时检测CK、CK－MB、cTnT，并绘制曲线加以分析比较。结果再灌注组CK、CK－MB、cTnT峰值出现时间提前，与未再灌注组之间有显著性差异。AMI发病12小时（h）以内再灌注组的CK、CK－MB、cTnT浓度分别大于未再灌注组，尤以发病后10h，12h为著。cTnT峰值浓度的升高明显高于CK、CK－MB者。结论动态观察cTnT浓度曲线变化显示与CK、CK－MB浓度曲线变化相似，且更特异、更灵敏，可作为判断溶栓再灌注的又一重要参考指标。

Objective To approach into the clinical value of cardiac troponin T (cTnT) inthe judgement of reopening the coronary vessels by observing dyndrically the law of changes in activity of creatine kinase (CK), CK - muscle brain hybrid iasenzyme (CK - MB)and conentrationof cTnT in patients with acute myocardial infarction (AMI) after thrombolytic therapy. MethodsThirty seven patients with AMI receiving thrombolytic therapy were seforted and divided into reperfusion group and non - reperfusion group. The patients' blood samples were taken before therapyand at certain intervals of time after onset of disease, CK, CK - MB and cTnT were detected andtheir variation curves were drawn for analysis and comparison. Resul The peak Values in variationcurves of CK, CK - MB and cTnT in the reperfusion group appeared earier than thase in the nonreperfusion group, showing significant difference. 12 hours within the onset of AMI, the CK, CKMB and cTnT concenimtions in the reperfusion group were higher than those in the non - reperfusiongroup, especially between 10h and 12h. The increasing peak value of cTnT was much higher thanthat of CK and CK - MB. Conclustion Dynamic observation of changes in cTnT concentration curveshows similar results as those in CK and CK - MB, but more specific and more sensitive. It is suggested that cTcT may be regarded as a reference index for the judgement of thrombolytic reperfusion.