体外循环心内直视手术患者血清心肌肌钙蛋白Ⅰ检测的临床意义

目的观察体外循环心内直视手术患者血清心肌肌钙蛋白Ⅰ（cTnⅠ）的动态变化,探讨血清cTnⅠ对体外循环心内直视手术心肌损伤的诊断价值。方法采用双抗体夹心光化学法检测34例行体外循环心内直视手术患者（观察组）术前,术后6、12、24、48、72h和32例开胸非心脏手术患者（对照组）术前,术后12h的血清cTnⅠ水平,同时采用免疫抑制酶动力学法检测血清肌酸激酶同工酶MB（CK—MB）的活性。结果观察组术前血清cTnⅠ水平和CK—MB活性与对照组比较差异均无统计学意义（均P〉0．05）,术后12h血清cTnⅠ水平和CK—MB活性与对照组比较差异均有统计学意义（P〈0．01或P〈0．05）。观察组血清CK—MB活性术后6h开始升高,术后12～24h达高峰,术后48～72h基本恢复至术前水平;血清cTnⅠ水平术后6h开始升高,术后12h达高峰,术后72h有所降低,但仍高于术前水平。对照组术后12h血清cTnI水平与术前比较差异无统计学意义（P〉0．05）,血清CK—MB活性较术前显著升高（P〈0．01）。结论体外循环心内直视手术可引起心肌损伤。血清cTnⅠ水平检测优于血清CK—MB活性。血清cTnⅠ对体外循环心内直视手术心肌损伤有重要的诊断价值。     

心肌肌钙蛋白检测在体外循环手术中的临床意义

目的：研究心肌肌钙蛋白I(cTnI)在体外循环心脏手术中，采用不同的心肌保护方法，转流前后的变化，以便对各种心肌保护方法做进一步评价。方法：按照术中将术中心肌保护方法分三组：包括含钾晶体冷停博液灌注组；冷血停博液灌注组；常温不阻断主动脉组。各组均于转流前后取静脉血，进行(cTnI)检测。结果：所有病例转流前cTnI均为阴性，转流后均为阳性。结论：在体外循环心脏手术中无论采取何种心脏保护方法，心肌均受到不同程度损伤。cTnI因其高敏感性和特异性，可作为心肌损伤的评价指标。     

心脏肌钙蛋白Ⅰ在体外循环病人的动态观察

目的研究心脏肌钙蛋白Ⅰ在体外循环病人手术前后的动态变化。方法应用微粒子化学发光酸免疫技术测定健康对照组，非心脏病病人对照组及体外循环病人血清心脏肌钙蛋白Ⅰ含量。结果健康对照组及非心脏病病人组cTnⅠ.＜0.1ng／ml，体外循环病人术前cTnⅠ.含量0.039±0.145ng／ml，术后4小时1.117±1.327ng／ml，术后24小时3.030±1.583ng／ml，术后120小时0.260±0.527ng／ml。结论cTnⅠ血清水平在体外循环病人的动态检测反映了心肌损伤程度，是良好的监测报标。     

心脏手术前后心肌肌钙蛋白T和心肌酶谱的变化

目的：探讨血清心肌肌钙蛋白T（cTnI）和心肌酶谱在心肌手术损伤前后的变化及其临床意义。方法：动态观察20例二尖瓣瓣膜置换术患手术前,术后2h及24h血清cTnI和心肌酶谱变化。另制备家兔心肌损伤模型,检测动物模型伤前和伤后4,8,24h血清cTnI的变化特点。结果：二尖瓣瓣膜置换术患血清cTnI含量,心肌酶谱尖性在术后2,24h较术前显升高（P＜0．01）,其中血清cTnI含量术后2h增加倍数高于其他指标。家兔心肌损伤模型伤后4,8,24h血清cTnI含量较伤前或高非常显（P＜0．01）,呈后期大峰值双基线。结论：血清cTnI含量及心肌酶谱活性均对心肌损伤的诊断有意义,但cTnI的心肌特异性及早期灵敏度更高,cTnI后期峰值对心肌损伤的预后判断有重要价值。     

川崎病患儿治疗前后血清肌钙蛋白Ⅰ的变化及其临床意义

目的:探讨静脉注射免疫球蛋白(IVIG)在川崎病(KD)治疗前后血清心肌肌钙蛋白I(cTnI)浓度变化的临床 意义。方法:检测KD(n=48)组治疗前后及对照组(n=30)患儿血清cTnI、肌酸激酶(CK)、乳酸脱氢酶(LDH)与谷 草转氨酶(GOT)的浓度。结果:KD组cTnI血清浓度明显高于对照组。KD组血清CK,LDH,GOT浓度与对照组 比较差异无显著性意义。IVIG治疗后cTn浓度明显低于治疗前。结论:cTnI对KD患儿急性期心肌损伤有早期 诊断价值;可以指导早期IVIG治疗,并可作为IVIG疗效观察指标,从而减少KD患儿心肌病变的发生。     

不同左心室构型甲亢性心肌病兔血清肌钙蛋白Ⅰ水平变化

目的探讨不同左心室构型甲状腺功能亢进症(简称甲亢)性心肌病兔血清肌钙蛋白I(cTn-I)水平变化。方法实验组兔(20只)腹腔注射左甲状腺素(45μg·kg-1·d-1×28d)建立甲亢动物模型,并依据Ganau的超声参数分为两型:向心性肥厚组(CH组)和离心性肥厚组(EH组);对照组兔(10只)每日腹腔注射生理盐水至实验结束;对各组兔均行超声心动图检查,并测定血清中cTn-I水平。结果 CH组左心室质量指数(LVMI)及相对室壁厚度(RWT)明显增加(P<0.01);左心室射血分数(LVEF)、短轴缩短率(FS)与对照组比较差异无统计学意义(P>0.05)。EH组LVMI明显增加(P<0.01),而RWT与对照组比较差异无统计学意义(P>0.05);LVEF、FS与对照组比较明显减低(P<0.01)。CH组和EH组血清cTn-I水平明显高于对照组(P<0.01),EH组较CH组血清cTn-I水平高(P<0.01)。血清cTn-I水平与LVMI呈正相关。病理学结果EH组损伤较CH组重。结论不同左心室构型甲亢性心肌病兔血清cTn-I水平具有不同程度的升高,并与病理损害程度基本一致。     

川崎病患儿血清肌钙蛋白Ⅰ的变化及其意义

目的探讨静脉注射免疫球蛋白（IVIG）治疗川崎病（KD）前后血清心肌肌钙蛋白Ⅰ（cTnⅠ）浓度变化的临床意义.方法检测KD（n=42）组治疗前后及对照组（n=28）患儿血清cTnⅠ、肌酸激酶（CK）、乳酸脱氢酶（LDH）与谷草转氨酶（GOT）的浓度.结果KD组血清cTnⅠ浓度明显高于对照组.CK、LDH、GOT浓度与对照组比较差异无显著性意义.IVIG治疗后cTnⅠ浓度明显低于治疗前.结论cTnⅠ对KD患儿急性期心肌损伤有早期诊断价值;可以指导早期IVIG治疗,并可作为IVIG疗效观察指标,从而减少KD患儿心肌病变的发生.     

电惊厥大鼠心电图及血清心肌肌钙蛋白Ⅰ的变化

目的：观察电惊厥大鼠癫痫发作时及发作后心电图变化，并检测动态血清心肌肌钙蛋白Ⅰ的变化。方法：实验于2004-10／12在重庆医科大学附属第一医院中心实验室进行。选20只SD大鼠，用电惊厥仪致痫动物。刺激条件：最大电休克用交流电500Hz，50mA，0.3s。刺激后大鼠100％惊厥发作，以双后肢强直为指标，用标准Ⅱ导联记录发作前、发作时以及发作后的心电图变化，用化学发光法动态检测大鼠惊厥前及惊厥后6，12，24h血清心肌肌钙蛋白水平的变化。结果：20只大鼠均进入结果分析。①血清心肌肌钙蛋白水平：惊厥6h即增高，12h达高峰，24h下降，均高于惊厥前[（9．51&;#177;3．68），（21．7&;#177;6．53），（7．26&;#177;1．95），（0．48&;#177;0．31）μg／L，P〈0．01]。②心电图表现：表现为伴有窄QRS复合波的窦性心动过速。异常主要表现为ST段下降、ST段抬高、T波倒置以及心房纤颤。这种异常改变在癫痫发作停止后仍持续两三分钟。③心率：惊厥时较惊厥前明显增快[（467．6&;#177;56．8），（373．5&;#177;41．6）次／min，t=5．39，P〈0．01]，平均增加86.6次／min。结论：电惊厥大鼠癫痫发作可引起心电图异常改变。心肌肌钙蛋自在惊厥后的升高说明癫痫发作可引起心脏结构性损害。     

血清心肌肌钙蛋白Ⅰ测定在急性毛细支气管炎并心肌损害的意义

目的:探讨血清心肌肌钙蛋白Ⅰ(cTn Ⅰ)测定在急性毛细支气管炎并心肌损害的临床意义.方法:对76例急性毛细支气管炎患儿(观察组)进行cTn Ⅰ、肌酸激酶同工酶(CK-MB)测定,同期儿保门诊健康体检儿40例作为对照组进行比较.通过比较cTn Ⅰ与CK-MB阳性率,探讨cTn Ⅰ测定对早期发现急性毛细支气管炎并心肌损害的临床意义.同时观察组病例分别统计婴儿组(＜1岁)、幼儿组(≥1岁)cTn Ⅰ阳性率,并进行比较分析.结果:观察组血清中cTn Ⅰ及CK-MB浓度比对照组明显升高(P＜0.001),婴儿组比幼儿组的心肌损害更为多见.观察组患儿血清中cTn Ⅰ的阳性率大于CK-MB.结论:急性毛细支气管炎患儿心肌细胞膜受损;cTn Ⅰ在早期发现急性毛细支气管炎并心肌损害中具有重要的临床意义.     

酶联荧光分析法测定血清心肌肌钙蛋白I

目的对酶联荧光分析法(ELFA)检测血清心肌肌钙蛋白I(cTnI)进行方法学评价,并探讨其临床应用价值。方法系统研究ELFA法测定cTnI的精密度、灵敏度、线性范围、回收率、标准曲线的稳定性及干扰因素,并与酶联免疫吸附试验(ELISA)检测结果相比较。同时应用ELFA法测定50名正常人、62例非心肌梗死患者及53例急性心肌梗死(AMI)患者的血清cTnI水平。结果ELFA法检测cTnI的总CV值为2.58%～4.82%,分析灵敏度为0.05μg/L,线性范围0.1～50μg/L,稀释标本的平均回收率为101.2%,标准曲线至少可稳定14d。ELFA法(Y)与ELISA法(X)具有良好的相关性(Y=0.983X-0.148,r=0.996)。加入高浓度的胆红素、三酰甘油和血红蛋白对测定无显著性影响(P>0.05)。AMI患者血清cTnI[(18.6±4.8)μg/L]显著高于正常人[(0.068±0.014)μg/L]和非心肌梗死患者[(0.055±0.021)μg/L](P<0.01);cTnI诊断AMI的阈值为0.8μg/L,诊断敏感度、特异度、准确度分别为91.4%、93.8%、92.9%,阳性和阴性拟然比分别为14.6和0.09。结论ELFA法操作简便、结果准确可靠、自动化程度高,且检测快速,具有较高的精密度;cTnI是敏感、特异的心肌标志蛋白,适合在临床工作中推广应用。     

Brain resuscitation by extracorporeal circulation after prolonged cardiac arrest in cats

Objective Brain reanimation after prolonged ischemia is limited by post-ischemic reperfusion deficits (no-reflow phenomenon). The present study was undertaken to establish whether after 30 min cardiac arrest extracorporeal circulation is able to restore brain reperfusion and to promote functional and metabolic recovery.Design Adult normothermic cats were submitted to 30 min cardiac arrest by KCl-induced cardioplegia. Resuscitation was carried out by extracorporeal circulation (ECC) until spontaneous heart function returned. The quality of brain recovery was assessed 3 h later by electrophysiological recording and by imaging of the regional distribution of brain energy metabolites.Results In 6 of 10 cats cardiac sinus rhythm returned after 32±15 min. In the other 4 cats cardiac function did not return or only intermittently returned during the 3 h observation period. Cerebral blood flow measured by laser Doppler flowmetry returned to 102%±40% of control immediately after the beginning of resuscitation but then gradually declined to 43%±32% after 3 h despite normotensive perfusion. In all cats pupils started to constrict within less than 5 min of recirculation but in 2 animals they secondarily dilated 1.5 and 2 h later, respectively. Spontaneous EEG activity reappeared in 4 of the 6 successfully resuscitated cats after 111±40 min but failed to recover in the others. Bioluminescent imaging of ATP after 3 h recirculation revealed near-complete depletion throughout the brain in all 4 cats without cardiac recovery. Of the 6 successfully resuscitated cats 5 exhibited patchy areas of low ATP, glucose and pH in 22%–92% of the cross sectional area of brain; in one cat recovery of energy metabolism and acid-base homoiostasis was homogenous without any focal deficits. The cross sectional area of ATP recovery correlated directly with CBF and hematocrit and inversely with the plasma lactate level.Conclusions This study demonstrates for the first time that ECC is able to restore electrophysiological and metabolic brain function after cardiac arrest of as long as 30 min, but recovery is heavily restricted by delayed postischemic disturbances of recirculation. Progress in cardiac resuscitation by ECC requires substantial improvement in the efficiency of cerebrovascular reperfusion.     

Comparison of diagnostic performance of cardiac troponin I on the IMMULITE system with other automated troponin I assays in minor myocardial damage

An analytical and clinical evaluation of cardiac troponin I (cTnI) on the IMMULITE system is presented. The assay results were compared with those of the Stratus II and the Dimension RxL-HM.A between-run imprecision CV&lt;20% was found at a cTnI concentration of 0.23 µ g/L (functional limit of detection). On the basis of a reference study including 215 patients without ischemic heart disease (97.5th percentile: 0.294 µ g/L) and 36 patients clinically classified as having stable angina pectoris (&lt;0.22 µ g/L) a preliminary cutoff level of 0.3 µ g/L was defined. Assay linearity, sample stability, influence of sample material and method comparison studies were performed. In patients with Duchenne's disease, chronic hemodialysis treatment, pulmonary embolism, coronary artery bypass surgery and minimally cardiacsurgery thecTnI results ofthe IMMULITE agreed better with the Dimension RxL-HM than with theStratus II data.Of142 samples from patients with unstable angina 67 samples were classified as cTnI positive with the IMMULITE, 76 with the Dimension RxL-HM, and 62 with the Stratus II. In conclusion, the new assay is sensitive for the determination of cTnI and easy to perform within 45min.     

循环心肌肌钙蛋白Ⅰ自身抗体的检测及临床意义

目的 了解急性心肌梗死(AMI)和心肌炎患者循环内抗心肌肌钙蛋白Ⅰ(cTnI)自身抗体的阳性率,促进临床实验室正确认识和了解这种特异性自身抗体对cTnI检测的负性干扰.方法 建立检测cTnI自身抗体的ELISA方法,在121例AMI和24例心肌炎患者血清中进行cTnI自身抗体的筛查;采用Western Blot对cTnl自身抗体阳性血清进一步验证;通过回收试验分析cTnI自身抗体对cTnI检测干扰的特异性.结果 121例AMI患者中有10.74%(13/121)cTnI自身抗体阳性,24例心肌炎患者中有8.3%(2/24)cTnl自身抗体阳性.将cTnI-C融合蛋白(cTnI终浓度为0.625-100ug/L)加入1例cTnI自身抗体阳性的血清中进行回收试验,各浓度cTnI均出现不同程度的低回收,并呈正相关(Spearman相关系数=0.943,P=0.005);而加入正常人血清中的cTnI回收率则没有明显的改变(Spearman相关系数=0.377,P=0.461).当加入终浓度为20ug/L的cTnI时,13份cTnI自身抗体阳性的AMI患者血清中有5份回收率<80%.结论 心肌损伤患者循环中存在cTnI自身抗体并非罕见,所产生的负性干扰足以使cTnI的检测结果失真,应在临床实验室引起高度重视.     

体外循环对中性粒细胞超微结构的影响

目的:研究临床体外循环过程对人中性粒细胞超微结构的影响。方法：随机抽取年龄6—12岁先心病患儿20例，分别于术前24h、体外循环结束时抽取静脉血，制备电镜标本，透射电镜观察中性粒细胞超微结构变化。结果：与功能变化相对应，体外循环术后中性粒细胞超微结构发生了以下改变：细胞体积增大，表面形态不规则，伪足及突起普遍增多；胞质内低密度颗粒、致密颗粒显著减少，线粒体数量增多，结构模糊；膜性管道系统变化不一，核表面积增大。结论：体外循环刺激可引起中性粒细胞超微结构的一系列改变，是体外循环后中性粒细胞功能活化的内在基础。     

血清心肌肌钙蛋白对心肌损伤的临床诊断价值

目的　探讨定量分析肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)对心肌损伤程度评价的临床意义。方法　对80例心肌梗死患[急性心肌梗死(AMI)50例、陈旧性心肌梗死(OMI)30例]、100例心脏手术患、60例非心脏手术患和20例健康人进行了血清cTnT、cTnI、肌酸激酶同工酶(CK—MB)和肌酸激酶(CK)检测。结果　(1)血清cTnT、cTnI、CK—MB和CK检测心肌损伤的敏感度和特异性分别为cTnT(72.4％，100.0％)、cTnI(81.8％，100.0％)，CK—MB(54.6％，87.5％)和CK(64.8％，62.2％)。(2)AMI和心脏手术组cTnT、cTnI、CK—MB和CK四项指标浓度均显高于正常对照组(P＜0.01)。(3)急性心肌梗死组、心脏手术组3h内cTnT和cTnI阳性检出率分别为(50％，56％)和(44％，45％)，明显高于CK—MB(24％，22％)和CK(20％，28％)；急性心肌梗死组、心脏手术组5d后cTnT和cTnI阳性检出率为(70％，66％)和(66％，61％)，而CK—MB仅为(4％，6％)，CK仅为(8％，10％)。结论　血清cTnT、cTnI能确切反映急性心肌梗死、心脏手术等心肌损伤程度，具有较宽的诊断窗口时间，是心肌损伤较敏感和特异的血清标志物。     

小儿体外循环术中抑肽酶促进内源性白细胞介素-10释放的研究

目的　探讨小儿体外循环 (ECC)术中抑肽酶促进内源性IL 10释放的作用及量效关系。方法　按入选标准筛选病例并随机分成 6组 :对照组 (A1 组 ,n =15 ) ,小剂量抑肽酶组 (B1 组 ,n =15 ) ,大剂量抑肽酶组 (C1 组 ,n =15 ) ,激素组 (A2 组 ,n =2 0 ) ,激素 +小剂量抑肽酶组 (B2 组 ,n =2 0 ) ,激素 +大剂量抑肽酶组 (C2 组 ,n =2 0 )。用酶联免疫吸附试验法测定各患儿在术前 ,ECC 30min ,ECC结束后 2h ,2 4h ,7d5个时间点血清IL 10的浓度。结果　各组ECC 30min ,ECC结束后 2h血清IL 10浓度与术前相比显著增高 (P <0 0 1) ;且B1 、C1 组与A1 组相比 ,B2 、C2 组与A2 组相比及C1 组与B1 组比较 ,C2 组与B2 组比较 ,IL 10水平增高更为明显 ,各组间差异有显著性 (P <0 0 1) ;A1 、B1 组术后住院日明显延长 (P<0 0 5 )。结论　抑肽酶能促进内源性IL 10的释放 ,且药效与抑肽酶剂量呈正相关     

Accidental hypothermia with cardiac arrest: Complete recovery after prolonged resuscitation and rewarming by extracorporeal circulation

A 51-year-old male remained immersed in sea water (6°C) for 40 min. Brought ashore, the ECG showed asystole. Advanced life support was immediately commenced. On arrival in hospital his rectal temperature was 27°C, but continued to fall to 24°C. The ECG remained isoelectric. Cardiopulmonary resuscitation was continued until extracorporeal circulation was established 190 min after rescue. Upon rewarming ventricular fibrillation occurred which was converted to sinus rhythm with a bolus of lignocaine followed by D.C. conversion at 31.5°C. When rewarming was complete after 60 min, signs of severe heart failure became evident. Sternotomy and pericardiotomy were performed to exclude cardiac tamponade. After 60 min of re-perfusion the patient was be weaned from bypass supported by a high-dose vasopressor infusion and nitroglycerine. He was discharged after 13 days with no evidence of any permanent organ damage. Given the advantage of providing circulatory support, extracorporeal circulation may be useful when rewarming hypothermic victims with cardiac arrest.     

Evaluation of a new ultrasensitive assay for cardiac troponin I

OBJECTIVES: We evaluated the analytical and clinical performance of a new ultrasensitive cardiac troponin I assay (cTnI) on the ADVIA Centaur system (TnI-Ultra). DESIGN AND METHODS: The evaluation included the determination of detection limit, within-assay and between-assay variation and comparison with two other non-ultrasensitive methods. Moreover, cTnI was determined in 120 patients with acute chest pain with three methods. To evaluate the ability of the new method to detect MI earlier, it was assayed in 8 MI patients who first tested negative then positive by the other methods. RESULTS: The detection limit was 0.009 microg/L and imprecision was <10% at all concentrations evaluated. In comparison with two other methods, 10% of the anginas diagnosed were recategorized to MI. CONCLUSIONS: The ADVIA Centaur TnI-Ultra assay presented high reproducibility and high sensitivity. The use of the recommended lower cutpoint (0.044 microg/L) implied an increased and earlier identification of MI.     

慢性肾功能衰竭维持性血液透析患者血清心肌肌钙蛋白的变化

目的观察慢性肾功能衰竭(CPF)维持性血液透析患者心肌肌钙蛋白(cTnI)的异常变化。方法应用双抗夹心酶联免疫吸附法(FLISA)检测115例维持性血液透析患者和64例正常人的cTnI。结果 慢性肾功能衰竭组的血清cTnI水平为(0.20±0.52)ng/ml,显著高于健康对照组(0.03±0.05)ng/ml(P<0.05)。115例慢性肾功能衰竭维持性血液透析患者中31(27.0％)例有不同程度的胸闷、心悸等症状;有症状患者血清cTnI为(0.49±0.93)ng/ml,显著高于无症状患者(0.09±0.11)ng/ml,P相似文献