心肌损伤标记物在经皮冠状动脉腔内成形术中的应用研究

An applied study on myocardial injury markers in percutaneous trasluminal coronary angioplasty

目的 通过动态观察行经皮冠状动脉腔内成形术 (PTCA)患者血清心肌肌钙蛋白 I(c Tn I)及肌酸激酶同功酶 (CK- MB)的变化 ,部分病例测定血清心肌肌钙蛋白 T(c Tn T)及肌红蛋白 (Mb)浓度 ,以评价该手术对心肌的可能影响。方法 对 10 2例行 PTCA的冠心病患者 ,分别测定其术前 ,术后 6、12、2 4、48、72 h的血清c Tn I及 CK- MB水平 ,并进行分组比较相关因素 ,2 2例患者同时测定血清 c Tn T及 Mb浓度。结果 2 6例患者术前 c Tn I正常 ,术后 6 h升高 ,12～ 2 4h达峰值 ,48～ 72 h渐降至正常 ;48例术前术后 c Tn I均正常 ;2 0例术前术后c Tn I均高于正常值。 7例 CK- MB增高。 16例 c Tn I阳性者中 c Tn T增高 11例 ,Mb变化无规律。 c Tn I升高与球囊扩张总时间、扩张压力和扩张次数以及支架植入数有关。 16例血清 c Tn I阳性者中 11例检出阳性。结论 PTCA术可能会造成心肌微小损伤 ,c Tn I监测心肌损伤比 CK- MB更敏感 ,特异性更高 ,c Tn T与 c Tn I有相似的作用 ,但敏感性稍差。而用 Mb监测作用有限。

Objective The changes of serum cardiac troponin I (cTnI) and creatine kinase MB (CK-MB) levels were monitored before and after percutaneous transluminal coronary angioplasty (PTCA) to evaluate the possible effect on myocardium in the procedure.Methods Serum cTnI and CK-MB were measured in 102 patients with coronary artery disease (CAD) undergoing PTCA before and at 6 th,12 th,24 th,48 th,72 nd hour after the procedure respectively,and serum cTnT (cardiac troponin T) and myoglobin were also measured in 22 cases.The relative factors were analyzed.Results The serum cTnI level of 26 cases began to increase 6 hours after PTCA,reaching its peak level in 12～24 hours and returning to normal in 48～72 hours.The serum cTnI level of 48 cases remained in normal range,but that of 20 cases was over baseline levels before and after the procedure,while CK-MB levels of 7 cases were slightly over normal range.Compared with normal cTnI group,elevated cTnI was related to total inflation time and dilated times as well as the number of stents implanted.Out of 16 cases with positive cTnI,11 showed the same result in cTnT test.Conclusion PTCA may cause some minor damage to myocardium.cTnI is more sensitive and specific than CK-MB in identifying the minor myocardial injury.cTnT is similar to cTnI in detecting myocardial injury.