动态监测血清肌钙蛋白I对病毒性心肌炎预后的临床价值

Changes of serum troponin I at different stages of viral myocarditis and their clinical significance

目的 探讨病毒性心肌炎 (VMC)患者血清肌钙蛋白I(cTnI)的动态变化与VMC近期预后的关系。方法 采用ELISA方法动态监测 3 8例VMC患者血清cTnI变化。分别以cTnI 1峰峰值 /cTnI 2峰峰值比值k和cTnI 1峰峰值下降幅度dcTnI为指标 ,分组观察VMC病程中血清cTnI、心电图和超声心动图各指标 (LVEDd、LVEF)变化。结果 VMC病程中血清cTnI水平呈双峰变化 ;病程 2个月及 6～ 12个月血清cTnI、心电图、LVEDd和LVEF指标 :k >1组分别与k <1组和dcTnI >5 0 %组比较 ,各指标差异均有非常显著性 (P均 <0 .0 1) ;6～ 12个月dcTnI>5 0 %组与dcTnI <5 0 %组比较 ,各指标差异均无显著性 (P均 >0 .0 5 )。结论 动态监测血清cTnI可反映VMC病情变化 。

Objective To evaluate the usefulness of various serum troponin I (cTnI)levels in patients with acute viral myocarditis(VMC).Methods By means of enzyme linked immunosorbent assay (ELISA),the concentration of serum cTnI was measured in 38 patients with VMC at different stages (admission,<2 week,2～4 week,4～8 week,3 month and 6～12 month).All cases were divided into two groups by decreasing range of cTnI-1st peak value (dcTnI>50% vs dcTnI<50%) or the ratio of cTnI-1st peak value to second(k>1 vs k<1).The left ventricular end-diastolic dimension (LVEDd) and left ventricular ejection fraction(LVEF) were detected by echocardiography and electrocardiogram(ECG) was detected too.Results Levels of cTnI were various in different stages of VMC.The concentrations of cTnI were significantly lower in the k>1 group than those in the k<1 group or the dcTnI>50% group after 2 months (both P<0.01).The LVEF and ECG were significantly better in the k>1 group than those in the k<1 group or the dcTnI>50% group after 6 months (both P<0.01),and there were no significantly difference about the LVEF and ECG between the dcTnI>50% group and the dcTnI<50% group (both P>0.05).Conclusion cTnI is related to the grades of myocardial injury in VMC.The peak-value ratio (k>1) may be viewed as a valuable index to evaluate the prognosis in VMC patients.