急性心肌梗死患者血清肌红蛋白水平在早期冠脉再灌流中的意义

Changes in Serum myoglobin level after thrombolytic treatment with urokinase for patients with acute myocardial infarction

目的 探讨急性心肌梗死患者尿激酶溶栓治疗过程中血清肌红蛋白 (Mb)的变化 ,判断其是否可以作为早期、非侵入性判断冠脉再灌流的指标。方法 对 2 2例尿激酶溶栓治疗和2 2例保守治疗的AMI患者治疗前后的 1h、2h、4h、8h、12h、14h、15h、18h和 2 4h的血清Mb进行测定 ,同时测定血清磷酸肌酸激酶同工酶 (CK MB) ,比较再灌流组和未再灌流组血清Mb的峰浓度和达峰时间 ,并同CK MB进行比较。结果 再灌流组血清Mb和CK MB的峰浓度分别为 6 19 5 9±198 5 5ng/ml和 15 7 10± 36 19u/L ,均显著高于未再灌流组 (487 31± 6 0 87ng/ml和 141 80± 2 2 18u/L) ;再灌流组较未再灌流组血清Mb达峰时间明显提前 (192min对 480min ,P <0 0 1) ,再灌流组血清Mb达峰时间显著早于血清CK MB达峰时间 (192min对 72 0min ,P <0 0 1) ,而且Mb的 2h出现率 (Mb2 /Mb0 )较未再灌流组也显著增高 (4 2 4对 2 12 ,P <0 0 1)。结论 血清Mb值早期上升、快速达峰是一种可靠、简便的非侵入性判断AMI再灌流治疗成功与否的指标。

Objective To investigate changes in serum myoglobin(Mb)level during intravenous thrombolytic therapy with urokinase(UK) in patients with acute myocardial infarction(AMI).Methods Serum Mb and creatine kinase isoenzyme MB were simultaneoushy measured in 22 cases of UK treated AMI patients and 22 cases AMI patients treated with conservative therapy before and 1,2,4,8,12,14,15,18 and 24 hours after treatment.Peak values and the median time to peak value of Mb and CK MB were compared between reperfusion group and non reperfusion group.Results Peak values of serum Mb and CK MB in reperfusion group were 619 59±198 55ng·ml 1 and 157 10±36 19μ·L 1 respectively,and significantly higher than those in non reperfusion group(487 31±60 87ng·ml 1 and 141 80±22 18u·L 1 ).Time to peak value in reperfusion group was shorter than that in non reperfusion group(192 min vs 480 min,P<0 01) and time to peak value of CK MB in reperfusion group(192 min vs 720min,P<0 01) as well.Mb appearance rate caculated as concentration at 2 hours after treatment divided by baseline values(Mb2/Mb0) was also higher in reperfusion group than that in non reperfusion group(4 24 vs 2 12,P<0 01).Conclusion An early rise and a peak in serum myoglobin values seems to be a reliable and simple non invasive indicator of successful reperfusion therapy.