急性心肌梗死直接经皮腔内冠状动脉成形前后CK-MB的动态变化

Serial Changes of CK - MB in Acute Myocardial Infarction Treated by Primary Percutaneous Transluminal Coronary Angioplasty

目的:探讨急性心肌梗死(AMI)直接经皮腔内冠状动脉腔内成形(P-PTCA)前后肌酸磷酸激酶的同工酶CK-MB的动态变化,以明确P-PTCA后梗死相关动脉(IRA)开通的CK-MB峰值出现的时间及其最佳切点。方法:确诊为透壁性AMI的患者90例,分别给予重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓、P-PTCA和药物非再灌注治疗三组,从A-MI发病至发病后96小时观察CK-MB的动态变化。并以AMI后CK-MB峰值出现的不同时间为切点,分别计算各个切点对于检出IRA开通的敏感度和特异度,试找出敏感度和特异度相对较佳的CK-MB峰值时间。结果:(1)rt-PA静脉溶栓后CK-MB峰值出现于发病后(11.9±4.4)小时,P-PTCA后CK-MB峰值出现在发病后(12.10±4.12)小时,二者均较AMI非再灌注治疗组明显提前,但rt-PA静脉溶栓组和P-PTCA组间的CK-MB峰值提前的时间相比差异无显著性。(2)rt-PA静脉溶栓组的CK-MB峰值的最佳切点在AMI发病后14小时左右;P-PTCA组CK-MB峰值的最佳切点在AMI发病后13小时前后。结论:AMI患者成功的进行P-PTCA后,CK-MB的峰值出现在发病后的8～16(12.10±4.12)小时,判断P-PTCA后IRA开通的最佳切点可能在AMI发病后13小时前后。

Objective: To explore the serial change of creatine kinase - muscle bone (CK - MB ) after primary percutaneous translumi-nal coronary angioplasty(P - PTCA)in patients with acute myocardial infarction (AMI) and find the optimal cut - off point of the CK -MB peak after patent of infarction related artery (IRA) . Methods: 90 cases of transmural AMI were classified into 3 following groups: rt - PA thrombolysis, P - PTCA, non - reperfusion. The serial changes of CK - MB were observed from the onset through 96 hours after AMI. By using the different cut - off point of CK - MB peak, the author calculated each sensitivity and specificity of each point to find the optimum cut - off point for judging patent of IRA after P - PTCA. Results: (1)The peak time of CK - MB was (11.9±4.4) hours after the onset of AMI in rt - PA group, whereas the peak time of CK - MB was (12.10±4.12) hours after the onset of AMI in P - PTCA group. Both were significantly earlier than non - reperfusion group. But there was no significant difference between rt - PA group and P - PTCA group. (2) The optimal cut - off point of CK - MB in rt - PA group was about 14 hours after the onset of AMI, while the optimal cut - off point of CK - MB in P - PTCA group was about 13 hours after the onset of AMI. Conclusion : The peak time of CK - MB was 8-16 (12.10±4.12 ) hours after successful P - PTCA in patients with AMI. The optimal cut - off point of judging patent of IRA after P - PTCA may be 13 hours after AMI.