血清心肌肌钙蛋白对心肌损伤的临床诊断价值

Significance of cardiac troponin in the diagnosis of myocardial damage

目的 探讨定量分析肌钙蛋白 T(c Tn T)、肌钙蛋白 I(c Tn I)对心肌损伤程度评价的临床意义。 方法 对 80例心肌梗死患者 [急性心肌梗死 (AMI) 5 0例、陈旧性心肌梗死 (OMI) 3 0例 ]、1 0 0例心脏手术患者、60例非心脏手术患者和2 0例健康人进行了血清 c Tn T、c Tn I、肌酸激酶同工酶 (CK-MB)和肌酸激酶 (CK)检测。 结果 (1 )血清 c Tn T、c Tn I、CK-MB和 CK检测心肌损伤的敏感度和特异性分别为 c Tn T(72 .4% ,1 0 0 .0 % )、c Tn I(81 .8% ,1 0 0 .0 % ) ,CK-MB(5 4.6% ,87.5 % )和 CK(64.8% ,62 .2 % )。 (2 ) AMI和心脏手术组 c Tn T、c Tn I、CK-Μ B和 CK四项指标浓度均显著高于正常对照组(P<0 .0 1 )。 (3 )急性心肌梗死组、心脏手术组 3 h内 c Tn T和 c Tn I阳性检出率分别为 (5 0 % ,5 6% )和 (4 4 % ,45 % ) ,明显高于 CK-MB(2 4% ,2 2 % )和 CK(2 0 % ,2 8% ) ;急性心肌梗死组、心脏手术组 5 d后 c Tn T和 c Tn I阳性检出率为 (70 % ,66% )和 (66% ,61 % ) ,而 CK-MB仅为 (4 % ,6% ) ,CK仅为 (8% ,1 0 % )。 结论 血清 c Tn T、c Tn I能确切反映急性心肌梗死、心脏手术等心肌损伤程度 ,具有较宽的诊断窗口时间 ,是心肌损伤较敏感和特异的血清标志物。

Objective To investigate the diagnostic value and significance of cardiac troponin T (cTnT) and troponin I (cTnI) in myocardial damage caused by acute myocardial infarction (AMI) and heart operation. Methods Sera from 80 patients with myocardial infarction [50 AMI cases, 30 old myocardial infarction (OMI) cases], 100 patients with heart operation, 60 patients with non heart operation and 20 healthy controls were examined for cTnT, cTnI,CK and CK MB by enzyme immunosorbent assay and other physiochemical methods. Results (1) The sensitivity and specificity for myocardial damage were cTnT (72 4%,100 0%),cTnI (81 8%,100 0%),CK(64 8%,62 2%) and CK MB (54 6%,87 5%) respectively. (2) In AMI and heart operation groups, the concentrations of cTnT,cTnI,CK and CK MB rose up.4 indexes in AMI and heart operation groups were higher significantly than those in healthy controls ( P <0 01).(3) During 3 h after AMI or heart operation, the positive rates of cTnT(50 0%) and cTnI(44 0%) were significant higher than those of CK(20 0%) and CK MB(24 0%).In heart operation group, the positive rates of cTnT(56%) and cTnI(45%) were also significant higher than those of CK (28%) and CK MB(22%).At the 5th day after AMI or heart operation, the AMI positive rates were 70% (cTnT),66% (cTnI),4% (CK MB) and 8% (CK). In heart operation group, the positive rates were 66% (cTnT),61% (cTnI), 6% (CK MB) and 10% (CK).\ Conclusion\ The content of serum cTnT and cTnI can closely reflect the extent of myocardial damage in acute myocardial infarction and heart operation. They provide a longer diagnostic window for detection of myocardial injury than of CK and CK MB.Serum cTnT and cTnI are markers with high sensitivity and specificity for myocardial damage and can aid the diagnosis of AMI or myocardial injury.