肌钙蛋白T诊断急性心肌梗死及判断溶栓疗效的意义

Significance of Troponin T in diagnosis of acute myocardial infarction and in evaluation of thrombolytic effect

目的 探讨心肌肌钙蛋白T(cTnT)诊断急性心肌梗死 (AMI)及判断溶栓后再通的价值。方法 用ELISA法测定 3 7例AMI患者溶栓治疗前后血清cTnT的动态变化 ,并与血清心肌型肌酸激酶同工酶 (CK MB)相比较。结果 (1)在AMI发生后 6h ,有 92 6%的患者cTnT增高 ,敏感性明显高于CK MB ;cTnT增高幅度大 ,持续时间长 ,与CK MB比较差异均有显著意义。 (2 )溶栓再通组cTnT多呈双峰型曲线 ,首峰浓度 /二峰浓度值 >1 0 ;未通组多呈单峰型曲线。 (3 )以cTnT出现首峰时间≤ 16h和 12h浓度 /2 4h浓度值 >1 0作为冠脉再通指标 ,两指标判断再通的敏感性均为 91 3 % ,特异性分别为67 1%和 78 6% ,两指标结果符合性好。结论 cTnT是反映心肌细胞损伤敏感性高、特异性强的生化指标 ,动态观察cTnT的变化 。

Objective To evaluate the value of cardiac Troponin T(cTnT) in diagnosis of acute myocardial infarction(AMI) and identification of reperfusion after thrombolysis.Methods cTnT was determined by ELISA in 37 patients with AMI before and after thrombolysis,and the results measured were compared to MB isoenzyme of creatine kinase (CK?MB).Results cTnT increased in 92.6% cases 6 hours after AMI,the sensitivity was apparently higher than CK?MB(P<0.05).The cTnT increased was significantly different from CK?MB(P<0.01) in the range and the duration.cTnT appeared in double-peak curve in general cases of the reperfusion group and the ratio of the concentration of the first peak/the second peak>1.0,but there were usually simple-peak curve in patients with non-reperfusion.To take the time of the first peak of cTnT≤16?h and the ratio of the concentration of T?12?h/T?24?h>1.0 as the criteria of vascular reperfusion,both of the sensitivities were 91.3% and the specificities were 67.1% and 78.6% respectively in identification of reperfusion after thrombolysis.Conclusion Serum cTnT was a more sensitive and more specific biochemical marker for myocardial cell injury.To monitor the variation of cTnT would have important clinical value in diagnosis of the early or the late AMI and in judgement of the vascular reperfusion in patients with AMI after thrombolysis.