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心肌梗死溶栓复流后血清标志物的变化及临床意义 被引量:4

The changes and clinical significance of serum markers in myocardial infarction patients after reperfusion
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摘要 目的评估肌红蛋白(Mb)/碳酸酐酶III(CAm)比值及肌酸激酶同工酶MB(CK—MB)作为一种无创标志检测溶栓后冠状血管复流的效果。方法研究对象为在我院治疗的107例患者,根据治疗方法不同将患者分为介入治疗组(n=54)与溶栓治疗组(n=53),检测两组患者的Mb、CAm与CK-MB释放水平的变化。结果溶栓治疗第1小时Mb水平提高(9.1±2.2)倍,CK—MB提高(10.8±3.3)倍,CAⅢ维持不变。第2小时Mb/CAⅢ比值达到峰值,第8小时CK—MB达到峰值。根据经皮冠状动脉腔内血管成形术(PTCA)过程中再灌注时间以及血清酶学的变化可知Mb/CAⅢ比值在3h内、CK-MB在10h内达到峰值可以作为再灌注的标志。溶栓后3-4h采样,有41例患者的Mb/CAⅢ比值在早期超出界值(3倍),此时采样结果最优。结论Mb/CAm比值能有效评估急性心肌梗死(AMI)患者再灌注的成功率并可筛查需接受PTCA的患者。 Objective To evaluation of the myoglobin/carbonic anhydrase Ⅲ ( Mb/CA Ⅲ ) ratio and MB isoenzyme of creatine kinase ( CK - MB) as a noninvasive marker in detecting coronary artery reperfusion after thrombolysis. Methods The study consisted of 107 cases of acute myocardial infarction. 54 patients received thrombolytic therapy( interventional therapy group, n =54), 53 patients undergoing coronary angioplasty( thrombolytic therapy group, n = 53). The Mb/CA Ⅲ ratio and CK - MB were measured in the course of treatment. Results Thrombolytic therapy was followed by a (9.1 ± 2.2) fold increase in myoglobin and ( 10.8 ± 3.3) fold increase in CK - MB fraction during the first hour of treatment, while CAm remained unchanged. The peak value of Mb/CAⅢ ratio was found at 2 h and that of CK - MB fraction at 8 h after thrombolysis. The reperfusion time point during primary angioplasty and follow - up of cardiac markers revealed that cut - off points of 3 and 10 h for the peak values of Mb/ CA Ⅲ ratio and CK - MB fraction can be used as indicators for reperfusion, respectively. Mb/CA Ⅲ ratio measured before treatment and 2 and 4 h after the onset of treatment screened 41 of those 45 patients with probable reperfusion after thrombolysis. Conclusion The serum Mb/CA Ⅲratio can be used' to evaluate the rate of infarction reperfusion success in patients with acute myocardial, and to screen the needs for percutaneous transluminal coronary angioplasty.
出处 《中国急救医学》 CAS CSCD 北大核心 2015年第12期1112-1116,共5页 Chinese Journal of Critical Care Medicine
关键词 急性心肌梗死(AMI) 肌红蛋白(Mb) 碳酸酐酶Ⅲ(CAⅢ) Acute myocardial infarction(AMI) Myoglobin(Mb) Carbonic anhydrase Ⅲ(CAⅢ)
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