比较高敏和普通肌钙蛋白Ⅰ在择期PCI手术前后的浓度变化

Evaluation of High-sensitivity and Ordinary Cardiac Troponin Ⅰ Assays after Elective Percutaneous Coronary Intervention

目的本研究比较了择期PCI手术患者术前和术后高敏感(hs-cTnⅠ)和普通敏感(con-cTnⅠ)心肌肌钙蛋白I的浓度变化差异。方法随机选取32例择期PCI手术患者,分别在术前和术后24小时采集血样,分离血清后,用雅培和贝克曼-库尔特两种化学发光方法同时检测。结果 PCI术后患者hs-cTnⅠ均值从0.013ng/ml升高到0.091ng/ml,高于99th百分位参考上限3倍,con-cTnⅠ均值从0.009ng/ml升高到0.061ng/ml,高于99th百分位参考上限1.5倍。术后的cTnⅠ浓度变化与术前的基线浓度相关性均很弱,且con-cTnⅠ较hs-cTnⅠ的相关性更弱(r=0.39 vs 0.42)。术前和术后的hs-cTnⅠ绝对浓度变化为0.081ng/ml(95%CI:0.036-0.125),con-cTnⅠ绝对浓度变化为0.056ng/ml(95%CI:0.027-0.084),二者具有显著差异(p=0.01)。hs-cTnⅠ在术后升高5和10倍的比例明显高于con-cTnⅠ的升高比例。随着hs-cTnⅠ变化幅度的增大(从>50%至>200%)住院天数逐渐延长,而con-cTnⅠ的浓度变化与住院天数的关联性并不明显。结论 hs-cTnⅠ在择期PCI手术前后的浓度变化幅度高于con-cTnⅠ,更有助于监测PCI相关的心肌梗死发生。

Objective In present study, the difference between high-sensitivity and ordinary cardiac troponin I assays were evaluated after elective pcrcutaneous coronary intervention（PC1）. Methods 32 patient undergoing elective PCI were randomly enrolled. The blood samples were collected and stored before and after PCI. The cardiac troponin concentration was measured employing Abbott and Beckman-coulter immunoassay systems for hs-cTnl and con-cTnl. Results The hs-cTnI level significantly increased from 0.013ng/ml to 0.091ng/ml bet＇ore and after PCI, which is 3-tblds 99^th percentile URL. The con-cTnl level was 1.5-folds 99^th percentile URL after PCI. The absolutely change value of hs-cTnl and con-cTnl were 0.081ng/ ml （95% CI, 0.036-0.125）and 0.056ng/ml （95% CI, 0.027-0.084）, respectively. According to third universal definition of myocardial infarction, the number of subjects with hs-cTnl concentration above 5-1bids and 10-folds was more than con-cTnl. The hospital stay were prolong companied with hs-cTnl change. Conclusion The hs-cTnl change value after PC1 was significantly higher than eon-cTnl. Hs-cTnl was more promising than on-cTnl when monitor PCl-reiated myocardial infarction.