冠脉内支架置入术对血清cTnT和D-dimer的影响

Effects of coronary stenting on blood levels of troponin T and D-dimer

目的 :比较冠脉内支架置入术 (CS)对血清心脏型肌钙蛋白 T(cardiac troponin T,c Tn T)和 D-二聚体 (D-dimer)的影响 ,以探讨其临床意义。方法 :进行 CS术的冠心病患者 4 8例 ,同时选择一组同期进行冠状动脉造影术(CAG)的冠心病患者作为对照 (n=30 )。分别于 CS或 CAG术前及术后第二天清晨采集空腹血进行血液 c Tn T及D- dim er水平的测定。结果 :CS的患者 ,CS术后血清 D- dim er水平显著高于术前 (分别为 1.4± 2 .0 mg/L vs0 .9±1.0 m g/L,P<0 .0 1) ;而 CS术后血清 c Tn T水平与术前比较无显著差异 (分别为 0 .38± 1.4 3ng/m l vs0 .30± 0 .32ng/ml,P>0 .0 5 )。CS术后有 6例患者 c Tn T增高 ,其中 5例发生在 D- dimer增高的患者中 (P<0 .0 5 )。CAG的患者 ,造影后血清 D- dimer及 c Tn T水平与造影前比较均无显著差异 (分别为 0 .5± 0 .5 mg/L vs0 .8± 0 .4 m g/L,P>0 .0 5及 0 .0 3± 0 .0 2 ng/ml vs0 .0 3± 0 .0 1ng/ml,P>0 .0 5 )。结论 :c Tn T为检测心肌损伤的敏感指标。CS术后血清 c Tn T水平稍有增加 ,而血清 D- dim er水平较术前显著增高。 D- dimer增高者易并发 c Tn

AIM: To examine the effects of coronary stenting (CS) on blood levels of cardiac troponin T (cTnT) and D dimer, and to evaluate their clinical significance. METHODS: Forty eight patients who underwent coronary stenting were included in this study, and thirty patients who received coronary angiography during the same period were selected as the controls. Blood samples for measurement of cTnT and D dimer were taken before the procedure and the following early morning after the procedure. RESULTS: In patients with coronary stenting, D dimer levels after the procedure were significantly higher than those before the procedure (1.4±2.0 mg/L vs 0.9±1.0 mg/L, P <0.01), but the blood levels of cTnT after the procedure were not significantly higher than those before the procedure (0.38±1.43 ng/ml vs 0.30±0.32 ng/ml, P >0.05). The blood levels of cTnT in six patients were higher after coronary stenting, five among whome were patients with increased D dimer ( P <0.05). In the control group, both D dimer and cTnT levels after coronary angiography were not significantly higher than those before the angiography (0.5±0.5 mg/L vs 0.8±0.4 mg/L, P >0.05 and 0.03±0.02 ng/ml vs 0.03±0.01 ng/ml, P >0 05, respectively). CONCLUSION: cTnT serum level was a sensitive marker for monitoring myocardial injury. The blood level of cTnT had rarely elevated after CS, but D dimer levels after CS were significantly higher than those before the procedure. The patienrs with increased D dimer were prone to cTnT elevation.