心肌损伤早期血液TroponinI及酶学标志的动态变化

目的探讨心肌损伤早期肌钙蛋白及心肌酶学的动态改变与规律。方法成年新西兰兔以10mg／kg体重，从耳静脉匀速滴注异丙肾上腺素制作动物心肌损伤模型。分别于实验前和实验中每隔30分钟抽取血液，以肝素抗凝并分析心肌肌钙蛋白I(cTnI)浓度，肌酸激酶(CK)、门冬氨酸氨基转移酶(AST)和乳酸脱氢酶(LDH)活性，同时观察心肌组织的病理学变化。结果心肌组织在滴注的早期表现为心肌间质增宽，其中见散在的炎细胞浸润，以嗜中性粒细胞为主，部分区域心肌纤维变细。在4h时心肌间隙明显增宽，间质疏松、水肿，伴浆细胞、淋巴细胞及少量嗜中性粒细胞浸润。整个过程中Asr活性增加20％，组间无明显差异(P＞0.05)。LDH活性2h前变化不明显，4h时为用药前的2倍。CK于损伤后3h明显异常(P＜0.05),4h时活性增加5倍。cTnI起初90min变化不明显，2h明显异常(P＜0.05),4h浓度升高4倍。AST与其他标志物的相关程度低，而CK、LDH和cTnI间相关性显著(r＞0.96)。结论外周血中CK水平和cTnI浓度异常是反映心肌早期损伤的最灵敏标志物。

Kinetic Alterations of Blood Myocardial Troponin I and Multiple Enzymatic Markers in Early Myocardial Damnification

To explore kinetic alterations and disciplinarian of blood myocardial troponin I and enzymatic markers in early of myocardial injury. Methods:The cardiac injury models of adult New Zealand rabbits were made by ear vein instillation with isopropyl epinephrine(10mg/kg b. w.). The levels of myocardial troponin l(cTn I), creatin kinase(CK), aspartate transamnase(AST)and lactatede hydrogenase(LDH)were detected before and per 30 mins during the experiment, and the changes of rabbit myocardial pathology were analyzed. Results:The myocardial pathology of early rabbit models demonstrated that cardiac muscle space became wider, inflammatory cell infiltrated with mostly neutrophil granulocytes, part cardiac muscle fibres became thinner and the space became significant wider,loosen,and edema accompanied with the infiltration of plasma cells,lymphocytes and little neutrophil granulocytes at 4 h. The activity of AST was 20% during the cardiac muscle injury and no significant difference was found between groups (P>0.05). The LDH activity wasn't obvious 2 h before and doubly increased at 4 h.CK activity was significant abnormity (P<0.05) and increased five times at the end of experiment. The change of cTnl wasn't obvious at the first 90 mins,and was significant abnormity (P<0.05) at 2 h and increased four times at 4 h. Positive correlation was found between CK, LDH and cTnl except AST( r >0.96). Conclusion; Abnormal concentrations of CK and cTnl in peripheral blood are the most sensitive markers for early cardiac muscle injury.