摘要
目的通过分析急性心肌梗死患者血清中肌钙蛋白I抗体水平的变化,探讨其在急性心肌梗死中的临床意义。方法 2011年4月-2012年3月急性心肌梗死68例,分别于确诊及确诊后24 h内取静脉血检测肌钙蛋白I(cTnI)及肌钙蛋白I自身抗体,根据检测结果分为肌钙蛋白I自身抗体阳性组(13例)及阴性组(55例)。比较两组患者确诊时及24 h血清cTnI水平,同时采用Gensini积分和SYNTAX评分评价冠脉病变程度;分别记录、比较两组于确诊7 d及随访180 d的左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD),评价肌钙蛋白I自身抗体与急性心肌梗死患者近期、远期的心功能变化的关系。结果两组患者确诊时cTnI水平无显著性差异,但24 h cTnI阳性组水平[(13.57±7.38)μg/L]明显高于阴性组[(7.37±9.24)μg/L](P<0.01);两组中多支病变患者比例差异无统计学意义,但阳性组Gesini积分(85.54)、SYNTAX积分(15.73)明显高于阴性组(Gesini积分52.73,SYNTAX积分9.99)(P<0.01),PCI术后7 d与180 d两组患者的左室重构指数、LVEF也存在显著差异(P<0.05)。结论肌钙蛋白I自身抗体可能影响急性心肌梗死患者早期cT-nI的浓度,并导致cTnI峰值的延迟;而肌钙蛋白I自身抗体阳性往往提示患者血管病变较重,心肌梗死时累及范围较广,梗死面积较大。远期随访结果提示,肌钙蛋白I自身抗体的存在可能影响心肌梗死患者术后心功能的恢复。
Objective To Analyze the variation of troponin autoantibodies in patients with acute myocardial infarction, to study on the clinical significance of testing troponin autoantibodies. Methods 68 patients confirmed AMI in our department during A- pril 2011 and March 2012 were taken venous blood for the test of troponin I and troponin autoantibodies titer. The diagnosis was con- firmed and within 24 h after diagnosed according to the test results. All cases were divided into troponin autoantibody-positive group （ 13 positive group） and troponin autoantibody-negative group （55 negative group）. Comparison was made on the troponin levels while diag- nosis was confirmed, between the groups on the troponin levels within 24 h after diagnosed, and the immediate angiography results. Coro- nary artery lesion was evaluated by Gensini integral and SYNTAX index. The left ventricular ejection fraction （LVEF） ,left ventricular end-diastolic diameter （LVEDD） ,left ventricular end systolic diameter （LVESD）were comparedat 7 days and 180 days after diag- nosed. The relationship between troponin autoantibody and the changes of cardiac function of patients with AMI in short-term period and long-term period were evaluated. Results There was no statistically significant difference in the levels of Troponin autoantibody positive group while diagnosed. However,the troponin levels 24 h after diagnosed were significantly higher than negative group （P 〈 O. 01 ）. In the positive group, the probability of muhivessel disease is much higher than the negative group. The Gesini integral and SYNTAX index of the positive group are higher than that of the negative group （P 〈0.01 ）. At 7 days and 180 days after diagnosed,the BNP level of Troponin autoantibody-positive group was significantly higher than that of negative group （P 〈 0.01 ）. The left ventricular remodeling in- dex LVEDD and LVESD of positive group were higher than negative group （ P 〈 0.05 ）, and EF is lower （ P 〈 0.05 ）. Conclusion The Tro
出处
《东南国防医药》
2013年第1期14-17,共4页
Military Medical Journal of Southeast China
关键词
肌钙蛋白Ⅰ
自身抗体
急性心肌梗死
心功能
troponin
autoantibody
acute myocardial infarction（AMI）
cardiac function
