心力衰竭患者运动前后血清肌钙蛋白I水平分析

Measurements of level of cardiac troponin I in patients with heart failure before and after exercises

目的 观察中度心力衰竭患者在症状限制运动试验和运动训练期后是否会增加心肌钙蛋白I(CTNI)。方法 30例中度心力衰竭患者 (NYHA分级Ⅱ～Ⅲ级 ,射血分数 31.7%± 9.3% )与 10例轻度心力衰竭患者及 10例无心力衰竭受试者进行对比观察 ,所有人均经历了症状限制性运动试验和单期运动训练 (达最大心率的 80 %以上 ,持续时间 30min) ,分别测定其基础CTNI值、症状限制性试验后和运动训练后 1～ 5h时的CTNI值。结果 症状限制性运动试验后 ,中度心力衰竭患者CTNI值由 (37± 4 9)pg ml增加到 (73± 5 9)pg ml,其中 6例中度心力衰竭患者和 2例轻度心力衰竭患者的CTNI值升高到 10 0pg ml以上 ,但运动训练后则否。无心力衰竭的受试者无论是静息时或是运动后其CTNI值均较低 (P <0 .0 5 )。结论 中度心力衰竭患者在症状限制性运动试验后其CTNI值增加 ,其水平达到轻微的心肌损伤水平 ,这一现象对患者预后的影响值得进一步研究。

Objective To evaluate changes of cardiac troponin I(CTNI) levels before and after symptom-limited exercise in patients with moderate heart failure.Methods 30 patients with moderate heart failure (NYHAⅡ～Ⅲ,EF 31.7%±9.3%)were enrolled ,compared with 10 patients with mild heart failure and 10 subjects without heart failure.All subjects underwent a symptom-limited test and a exercise training session at >80% of maximal heart rate over 30 minutes.Plasma CTNI level were measured at baseline,after symptom-limited exercise hourly for 5 hours,and 1 to 5 hours after training. Results Patients with moderate heart failure showed an increase of CTNI from (37±49) pg/ml to (73±59) pg/ml(P <0.01) after symptom-limited exercise.6 atients with moderate and 2 patient with mild heart failure and normal CTNI values at rest showed the increases of CTNI above 100 pg/ml after acute exercise but not after training.Subjects without heart failure had lower CTNI levels at rest and significantly lower values after symptom-limited exercise and training( P <0.05 for each).Conclusion Patients with symptomatic heart failure showed an increase of CTNI after symptom-limited exercise at levels that indicate minor myocardial damage.The prognostic impact of this finding should,therefore,be further investigated.