心肌肌钙蛋白T在评价原发性扩张型心肌病预后中的作用

The value of cardiac troponin T in evaluates the prognosis of idiopathic dilated cardiomyopathy

目的 分析心肌肌钙蛋白T (cTnT)的长期变化与扩张型心肌病 (DCM)的关系及评价cTnT持续升高对DCM预后的影响。方法 利用酶联免疫吸附试验 (ELISA)对 1998～ 2 0 0 0年间通过冠状动脉造影确诊为DCM的5 6例患者进行多次cTnT浓度测定。结果 30例患者随访期间cTnT <0 0 2ng/ml (A组 ) ,其余 2 6例患者cTnT的起始浓度≥ 0 0 2ng/ml,其中 10例患者随访期间降至cTnT <0 0 2ng/ml (B组 ) ,另 16例患者 (C组 )即使按充血性心衰(CHF)常规处理 ,血清cTnT浓度还是持续升高。治疗前 3组患者的左室舒张内径 (LVDd)及左室射血分数 (LVEF)间的差别无显著性意义 (P >0 0 5 ) ,而治疗后差别有显著性意义 (P <0 0 5 )。结论 DCM患者血清cTnT持续升高提示存在进行性亚临床心肌细胞变性及预后不良。

Objective To analyze the correlation between long-term changes in cTnT concentrations and clinical symptoms in patients with DCM,and the value of persistently increased cTnT in evaluates the prognosis of DCM.Methods Multiple measurements of cTnT concentrations with enzyme linked immunosorbent assay(ELISA) were performed in 56 patients with DCM confirmed by coronary angiography between January 1998 and December 2000.Results 30 patients had concentrations of cTnT<0 02ng/ml throughout the follow-up period (group A).The remaining 26 patients had high initial serum concentrations of cTnT(≥0 02ng/ml).In 10 of these 26 patients,cTnT decreased to <0 02ng/ml during follow-up (group B),whereas 16 patients had persistently high serum cTnT concentrations despite being conventionally treated for congestive heart failure(CHF) (group C).Although the initial echocardiographic left ventricular diastolic dimension (LVDd) and left ventricular ejection fraction (LVEF) were not significantly different among the 3 groups,follow-up echocardiography showed significantly decreased LVDd and increased LVEF in group A (each P<0 01) and group B (each P<0 05) compared with increased LVDd and decreased LVEF in group C (each P<0 05).The cardiac event-free rate was significantly lower in group C than in group A and B (each P0 001),and the survival rate was lower in group C than in group A (P<0 05).Conclusion Persistently increased cTnT in DCM suggest ongoing subclinical myocyte degeneration associated with deterioration of the patients′ clinical status.