心肌肌钙蛋白T动态检测在急性心肌梗塞中的应用价值

Study on the Applicable Value of the Serial Measurement of Cardiac Troponin T in Acute Myocardial Infarction

目的 探讨血清心肌肌钙蛋白T(cTnT)的动态变化对急性心肌梗塞 (AMI)的诊断和判定冠状动脉再通的价值。方法 采用ELISA法动态检测了 5 7例接受尿激酶静脉溶栓治疗的AMI患者和 3 1例正常健康对照血清cTnT水平 ,并计算溶栓后 3h与 2h血清cTnT浓度比值。结果 ①cTnT释放呈现两种特征 ,再通组呈双峰型 ,未通组呈单峰型 ,且再通组后期峰值较未通组峰值低 (P <0 .0 1)。②cTnT的检测对发病 <3h的AMI患者敏感性为 43 .4% ,明显高于CK ,CK MB。③cTnT浓度 3h/2h比值再通组明显高于未通组 (P <0 .0 1) ,以该比值 >1.48作为判定再通的标准 ,其对判定冠状动脉再通的敏感性、特异性、预测值分别为 83 .3 % ,90 .5 % ,93 .8% ,与峰值时间判定冠脉再通比较差异无显著性 (P >0 .0 5 )。结论 cTnT的检测对AMI诊断具有早期和灵敏的特点 ,3h/2h浓度比值 >1.48可作为判定冠脉再通的标准且具有迅速、省时等优点 。

Objective To investigate the vale of serial change of serum cardiac troponin T(cTnT) in diagnosing acute myocardial infarction (AMI) and judging coronary reperfusion.Method The levels of cTnT in serum were measured with ELISA serially in 57 cases with acute myocardial infarction accepted intravenous thrombolytic therapy and 31 cases healthy individuals,then the cTnT concentration ratios of 3h after thrombolysis to 2h after thrombolysis were calculated.Result ①The release of cTnT showed two features.The reperfusion group had a bi phasic release pattern,while the non reperfusion group exhibited a mono phasic release.The peak of the second phase in reperfusion group was lower than that in the non reperfusion group (P<0.01).②The sensitivity of cTnT detection to patients within 3h of AMI was 43.4%,which was much higher than CK or CK MB.③The cTnT concentration ratios of 3h/2h in reperfusion group were significantly higher than that in non reperfusion group (P<0.01).The ratios higher 1.48 were applied to a standard for judging coronary reperfusion,which sensitivity,specificity and forecast value was separately 83.3%,90.5% and 93.8%.There was no significant difference between the ratio and the peak time for judging coronary reperfusion (P>0.05).Conclusion The detection of cTnT for diagnosing AMI was characterized by earliness and sensitivity.The cTnT concentration ratios higher 1.48 were applied to a standard for judging coronary reperfusion.