急性ST段抬高性心肌梗死患者再灌注治疗后心肌损伤指标动态变化的价值

The value of dynamic changes of myocardial injury indicators in reperfusion therapy for patients with acute ST elevation myocardial infarction(STEMI)

目的 探讨急性心肌梗死（AMI）患者血浆中的心肌标志物、高敏C反应蛋白（hs-CRP）、纤维蛋白原（Fib）及D-二聚体（D-D）水平的动态变化及其临床意义。方法 选取2012年4月-2014年6月于广安市人民医院心内科住院发病在12 h内的ST段抬高型心肌梗死（STEMI）患者98例,分别检测再灌注前、治疗后2h、6h、12 h、24 h、36 h、48 h、3d、4 d直至第7 d血浆中的肌红蛋白（MYO）、肌钙蛋白I（c Tn I）、肌酸激酶同工酶（CK-MB）、hs-CRP、Fib及D-D的水平变化。结果 MYO出现时间早,12-24 h达峰值,36 h后基本恢复正常;CK-MB16-24 h达峰值;c Tn I维持时间长,18-24 h达峰值;hs-CRP浓度逐渐下降;D-D在溶栓治疗6 h后达峰值;Fib经治疗后降低缓慢。结论 STEMI患者MYO和c Tn I的测定对早期诊断有重要意义;hs-CRP是对心肌损伤的判断有一定价值;D-D对治疗效果的监测也有一定意义。

Objective To discuss dynamic changes and clinical value of myocardial markers, hypersensitive c-reactive protein, fibrinogen and D dimer levels in patients with acute myocardial infarction（AMI）. Methods 98 patients of West China-Guang＇an Hospital from April 2012-June 2014 with ST-segment-elevation myocardial infarction（STEMI） who present within 12 hours of onset were selected. Myoglobin（MYO）, troponin I（c Tn I）, creatine kinase isoenzyme（CK-MB）, high-sensitivity C-reactive protein（hs-CRP）, fibrinogen（Fib） and D- dimer（DD） were measured before and after treatment for 2 hours, 6 hours, 12 hours, 24 hours, 36 hours, 48 hours, 3 days, 4 days and 7 days. Results MYO level peaked during 12 to 24 hours after treatment, and went back to normal after 36 hours. CK-MB level peaked during 16-24 hours after treatment. c Tn I level peaked during 18 to 24 hours after treatment. Level of hs-CRP dropped gradually. DD level peaked at 6 hours after treatment. Fib dropped slowly after treatment. Conclusion MYO and c Tn I of STEMI patients are valuable for early diagnosis. Hs-CRP has certain value for diagnosis of myocardial injury. DD has certain value for surveillance of treatment effect.