血清心脏肌钙蛋白浓度作为溶栓再灌注指标价值的研究

A CONTRAST STUDY OF VALUE OF AN INDICATOR OF THROMBOLYSIS REPERFUSION WITH SERUM CARDIAC TROPONIN T COMPARED WITH CARDIAC ENZYMES

目的 :观察AMI静脉溶栓治疗后患者血清中心脏肌钙蛋白 (cTn -T)释放动力学 ,绘出cTn -T浓度曲线 ,了解峰值特点 ;且将 (cTn -T)浓度动态变化与肌酸激酶 (CK)、肌酸激酶同功酶 (CKMB)浓度动态变化相比较 ,以确定AMI静脉溶栓治疗后患者血清中cTn -T的浓度动态变化可否作为溶栓再灌注指标之一。方法 :将 6 8例接受溶栓治疗的AMI患者 ,分成A组 (发病时间≤ 3.5h ,再灌注组 ) ,B组 (发病时间 >3.5h、再灌注组 )和无再灌注组 ,分别测定三组不同时间的cTn -T、CK和CKMB。结果 :A组、B组和未通组的CK、CKMB及cTn -T浓度动态变化有如下特点 :A组和B组峰值出现时间提前 ,且以前者为著 ,(F值分别为 :2 3.6 ,15 .2 5和 13.85 ;均P <0 .0 1) ,CK、CKMB与cTnT在A组与B组之间无显著性差异 (q分别为 :2 .5 7,1.71和 1.87;均P >0 .0 5 ) ;但未再灌注组与A和B组之间有显著性差异 (q分别为 :14.5 9,12 .0 2 ,9.6 3,7.9210 .92 ,9.5 0 ,均P <0 .0 1)。发病后的 12h以前CK、CKMB及cTn -T血清浓度分别 :A组 >B组 >未通组。A组、B组cTn -T浓度动态变化中有一平台期 ,未通组则无。再灌注组 (A组及B组 )血浆CK、CKMB和cTn-T 14/4 8h比值均 >1.0 ,而未再灌注组均 <0 .7(均P <0 .0 1) ,且cTn -T与CK、CKMB有显著性差异 (q分别为

Objective: This study was designed to investigate the release dynamic changes of serum cardiac troponin T (cTn-T), creatine kiase (ck) and isoenzyme MB (CK-MB) levels in patients of acute myocardial infarction (AMT) treated with thrombolysis, described the curve of cTn-T, ck and CK-MB serum concentration and compare them to what cTn-T may be a indicator of reperfusion. Methods: 68 cases of AMI were divided into A group (after onset of pain≤3.5h, reperfusion group), B group (after onset of pain>3.5h, reperfusion group) and no reperfusion group. CTn-T, ck and CKMB were simultaneously measured and cTn-T was measure determined by a immunometric one-step sandwich assay. Results: The curve of cTn-T seru, concentration in thrombolysis reperfusion group was binphasic. The time reaching the first cTn-T peak was earlier in thrombolysis reperfusion group than thrombolysis nonperfusion group (F=13.85 P <0.001); Curve all the release dynamic of cTn-T, ck and CK-MB peak serum concentration were no marked difference (F=0.19, 0.56, 2.84, P >0.05). Within 12h after onset of pain, cTn-T, ck and CK-MB serum concentration were a grou P >B grou P >no reperfusion group. The ratio of cTn-T at 14 to 48 hours after onset is a useful marker suggesting A group. Conclusions: The curve of cTn-T, ck and CK-MB serum concentration were similar; cTn-T may be a more useful and valuable one of indicator of thrombolysis reperfusion than cardiac enzymes.