血清肌钙蛋白T及血浆同型半胱氨酸在急性冠脉综合征中的作用

Relationship between total homocysteine and cardiac troponin T during acute coronary syndromes

目的 探讨急性冠脉综合征时高同型半胱氨酸血症和心脏肌钙蛋白T的关系 ,评价高同型半胱氨酸血症是否能导致心肌损伤程度加重。方法 AMI 5 3例 ,UAP 5 5例 ,采用荧光标记免疫检测法测定血浆同型半胱氨酸 (Hcy) ,酶联免疫法 (ELISA)测定肌钙蛋白T(cTnT)。结果 AMI组Hcy明显升高时cTnT也明显升高 ,Hcy大于 16 0 μmol/L时cTnT明显高于Hcy小于 7 7μmol/L(P <0 0 1) ,Hcy分别为 7 7、9 0、11 3、14 3、16 0 μmol/L时cTnT分别为 4 6 3、4 6、4 8、6 2、7 8μg/L ;UAP组同样 ,Hcy分别为 9 8、11 0、12 1、12 8、15 4 μmol/L时cTnT分别为 0 0 3、0 0 3、0 0 2、0 0 4、0 15 μg/L ,最高浓度组与最低浓度组方差分析显示P <0 0 1。UAP组cTnT阳性者血浆Hcy浓度比阴性者显著升高 (P <0 0 0 1)。结论 血浆同型半胱氨酸浓度升高与ACS时心肌损伤有关。

Objective This study was conducted to determine whether the amount of myocardial damage during acute coronary syndromes(ACS) was related to the level of plasma homocysteine concentration. Methods We studied patients with acute myocardial infarction(AMI)(n=53) and unstable angina pectoris (UAP) (n=57). Plasma samples were collected prior to clinical intervention and were assayed for homocysteine by fluoroimmunoassay. Myocardial necrosis was assessed by measurements of cardiac troponin T(cTnT). Results There was a significant increase in cTnT in the highest homocysteine quintile in AMI, the levels being 4.63, 4.6, 4,8, 6.2, 7.8 μg/L for quintile 1 to 5 respectively (P<0.01, for top vs bottom). Similarly, there was a significant increase in cTnT in the highest homocysteine quintile in UAP, the levels being 0.03, 0.03, 0.02, 0.04, 0.15 μg/L for quintile 1 to 5 respectively (P<0.01, for top vs. bottom). The patients with UAP were further examined according to cTnT levels below (cTnT negative) or above (cTnT positive) 0.1 μg/L. Homocysteine levels were significantly higher in cTnT positive patients than in cTnT negative patients. Conclusion Elevated homocysteine levels are associated with a higher risk of ischemic myocardial injury in patients with ACS.