摘要
目的近年来研究表明心肌损伤检测生化标志物中肌钙蛋白 I(c Tn I)有较好的敏感性和特异性。本研究旨在探讨冠状动脉支架置入术 c Tn I的释放及相关临床因素。方法 6 1例进行冠状动脉支架置入术的冠心病患者分别于术前、术后即刻、12小时、2 4小时检测磷酸肌酸激酶 (CK)、CK- MB、c Tn I,并采集临床、冠状动脉病变特征、手术过程、并发症等相关因素 ,并与 35例仅作冠状动脉造影的患者相比较。 CK>2 0 0 u/ l,CKMB>5 .6 ng/ m l,c Tn I>1.5 ng/ ml为心肌损伤临界值。结果 所有患者术前 c Tn I、CK、CK- MB均在正常范围。除 1例患者外其余患者均成功进行了支架置入术 ,无急诊冠状动脉搭桥术或死亡。术后 1例患者 CK升高 ,心电图证实为 Q波心肌梗死 ,其余患者 CK均在正常范围。成功进行支架置入术的 6 0例患者中术后 c Tn I及 CK- MB均升高 18例 ,c Tn I升高而 CK- MB正常 19例 ,CK- MB升高而 c Tn I正常 1例 ,CK- MB及 c Tn I均正常 2 2例。术后 c Tn I升高组同 c Tn I正常组比较 ,冠状动脉病变特征无显著性差异 ,术前冠状动脉内血栓形成及术中夹层、远端栓塞、急性闭塞并发症在 c Tn I升高组发生率相对较高 ,但无显著性差异。c Tn I及 CK - MB均升高组的术后 c Tn I、CK- MB水平较 c Tn I升高、CK- MB?
Objective Recent studies have suggested that immunoassay of cardiac troponion I(cTnI)provides a more sensitive and specific measurement of myocardial injury than creatine kinase MB(CK MB)mass. The purpose of our study is to compare the release of cTnI and CK MB mass in patients undergoing coronary stenting, and to investigate the relevant clinical status, coronary lesion morphology and complication related to the abnormal elevations of these markers. Methods cTnI, CK, CK MB mass were measured before and immediate,12h,24h after intervention respectively in 61 patients. All patients had normal levels of the three markers according to the reference limit (the diagnosis reference limit in our hospital is 200IU/L for CK, 5.6ng/ml for CK MB mass, 1.5ng/ml for cTnI). Postintervention levels of CK>200IU/L, CK MB>5.6ng/ml and cTnI>1.5ng/ml were considered indication of myocardial injury. Results coronary stenting was successfully performed in 60 of the 61 patients without emergency bypass surgery or death. One patient has an abnormal elevation of CK was identified as Q wave myocardial infarction by ECG. After coronary stenting , 18 patients had elevation of both CK MB and cTnI, 19 patients had elevation of cTnI only, 1 patient had elevation of CK MB only and 22 patients had no elevation of both. In comparing the patients who have normal cTnI level with those who have abnormal cTnI after intervention, the later had a higher incidence of coronary thrombus prior to the procedure, and a higher incidence of coronary dissection and abrupt closure during the procedure. However, there was no significant difference between the two groups. The two groups also had no difference in coronary lesion morphology. In the group with elevation of both cTnI and CK MB, post intervention cTnI levels were 2.2 fold higher and CK MB levels 9.4 fold higher than those in the group with elevation of cTnI only. Conclusion It is shown that about 60% of the patients undergoing coronary stenting may have minor myocardial injury as evidenced
出处
《中国心血管杂志》
2002年第4期245-247,276,共3页
Chinese Journal of Cardiovascular Medicine
