心肌肌钙蛋白Ⅰ早期诊断急性心肌梗死的价值

目的 :为了进一步探讨心肌肌钙蛋白Ⅰ (cTnⅠ )在早期诊断急性心肌梗死 (AMI)中的价值。方法 :对 30例急性心肌梗死 (AMI)、2 4例不稳定型心绞痛 (UA)和 6例其他非心血管病患者血清中心肌肌钙蛋白Ⅰ (cTnⅠ )、心肌肌钙蛋白T (cTnT)浓度进行测定。结果 :cTnⅠ和cTnT早期诊断AMI的敏感度分别为 90 % ,83.3% ,P >0 .0 5 ;两者的特异性分别为 96 .7%和 73.3% ,P <0 .0 5。cTnⅠ在AMI各时相显示 :AMI 3h开始升高 ,2 4h升至峰值 ,峰值可达临界值的 80倍。结论 :cTnⅠ对AMI早期诊断具有高灵敏度和高特异性 ,是目前诊断心肌损伤最特异性标志物     

心肌肌钙蛋白Ⅰ对急性心肌梗死的临床意义

目的 探讨心肌肌钙蛋白Ⅰ对急性心肌梗死的临床意义.方法 对73例急性心肌梗死患者测定cTn I和CK-MB,并且同时进行溶栓治疗,观察其动态变化.结果 急性心肌梗死患者血清cTn I和CK-MB开始升高时间,高峰出现时间在溶栓再通者中有非常明显差异（P〈0.01）,急性心肌梗死患者入院72 h后测定cTn I的特异性明显高于CK-MB（P〈0.005）.结论 监测cTn I比CK-MB对AMI患者更有意义.     

心肌肌钙蛋白Ⅰ与肌酸激酶同工酶对急性心肌梗死诊断价值的比较研究

目的研究比较心肌肌钙蛋白Ⅰ与肌酸激酶同工酶对急性心肌梗死的诊断价值。方法急性心肌梗死（AMI）患者45例，不稳定型心绞痛（UAP）患者42例，陈旧性心肌梗塞（OMI）患者47例，检测其血清中的肌钙蛋白Ⅰ（cTnⅠ）和肌酸激酶同工酶（CK—MB），cTnⅠ〉0．5ng／ml为阳性，CK—MB增高超过正常值为血清酶异常，对比观察三组患者的检测结果。结果AMI组cTnⅠ检测为阳性结果的例数明显高于UAP组及OMI组（P〈0．01），cTnⅠ诊断AMI的敏感性为100％（45／45），CK—MB为86．7％（39／45）；cTnⅠ诊断AMI的特异性为96．7％（86／89），CK—MB为55．1％（49／89）。rTnⅠ检测的敏感性和特异性均明显高于CK—MB。结论cTnⅠ对于诊断AMI较CK—MB具有更高的敏感性和特异性，且检测更方便、快捷，对AMI的诊断、鉴别诊断等具有重要意义，是一种新的更有价值的AMI诊断的特异性标志物。     

血清心肌肌钙蛋白Ⅰ和超敏C-反应蛋白在冠心病诊断中的研究

目的 探讨冠心病（CHD）患者血清心肌肌钙蛋Ⅰ（cTnⅠ）和超敏C-反应蛋白（hs—CRP）检测的临床意义。方法 采用化学发光法测定cTnⅠ，胶乳增强免疫比浊法测定hs—CRP，共检测22例稳定型心绞痛（SAP）、34例不稳定型心绞痛（UAP）、32例急性心肌梗死（AMI）患者，同时检测50例健康人群做对照。结果 SAP组的cTnⅠ水平与健康对照组无显著性差异p〉0．05，而hs—CRP水平明显高于健康对照组p〈0．01；UAP组、AMI组的cTnⅠ和hs—CRP水平均明显高于健康对照组p〈0．01；不同类型的CHD患者中cTnⅠ和hs-CRP浓度比较，AMI组UAP组〉SAP组p〈0．01。结论 cTnⅠ为心肌损伤的特异性指标，hs—CRP为心肌损伤的敏感性指标，两者联合检测对早期诊断CHD以及判断预后具有重要的意义。     

入院早期急性心肌梗死患者血清肌钙蛋白Ⅰ浓度与近、远期预后的关系

目的 探讨发病早期血清肌钙蛋白Ⅰ（cTnⅠ）水平在生心肌梗死（AMI）预后判断方面的意义。方法 53例胸痛后12h内入院的AMI患者在入院时及入院初取静脉血作血清cTnⅠ浓度检测，并对44例存活出院患者中的30例成功随访。安急性胸痛发作后的时间以及血清cTnⅠ浓度将患者分组，比较AMI早期血清cTnⅠ浓度与心脏事件的关系。结果 胸痛后6h入院且血清cTnⅠ升高者，住院期间死亡、心脏事件发生率明显升高，长期随访心功能明显下降。胸痛后6－12h入院者其入院时血清cTnⅠ均升高，超过90μg/L者住院期间心脏事件发生率有增高趋势，入院时心功能明显下降。结论 AMI 6h内血清cTnⅠ浓度升高对住院期间发生心脏事件的危险度有预测作用。     

检测心肌肌钙蛋白与心肌酶谱在急性冠脉综合征诊断中的意义

目的探讨心肌肌钙蛋白I（cTn-I）与心肌酶谱在诊断急性冠脉综合征（ACS）早期的意义。方法同时测定心肌肌钙蛋白和心肌酶谱的临床标本为统计对象，再以冠心病中的不同病种分类，分别比较其阳性率。结果在观察89例病例中，急性心肌梗死29例，cTn—I阳性率为91％，不稳定性心绞痛32例，cTn—I阳性率为56％。结论联合检测组心肌肌钙蛋白与心肌酶谱可大幅提高急性冠脉综合征的诊断率。     

心肌肌钙蛋白T诊断急性心肌梗死的临床价值

目的 探讨心肌肌钙蛋白T（CTnT)诊断急性心肌梗死的临床价值。方法 采用肌钙蛋白T全血快速检测方法，同时常规监测心肌酶学，对40例急性心肌梗死（AMI）及20例心绞痛患者进行对比观察。结果 AMI组40例24小时内CTnT均为阳性，不稳定型心绞痛有2例为阳性，后发展为AMI，16例稳定劳累型心绞痛均为阴性。结论 CTnT定性测定对诊断AMI敏感度高，具有早期诊断AMI的临床价值。     

心肌肌钙蛋白I在急性冠状动脉综合征中的临床价值

目的 探讨心肌肌钙蛋白I（TI）在急性冠状动脉综合征中的临床价值。方法 选择急性心肌梗死患者组38例，不稳定型心绞痛患者组42例，健康对照患者组36例，采用固相层析免疫分析技术定性检测心肌TI。结果 急性心肌梗死组、不稳定型心绞痛组患者心肌TI的阳性率明显高于健康对照组（P＜0．01），急性心肌梗死与不稳定型心绞痛组之间心肌 TI阳性率比较差异亦有显著性（P＜0．01）。结论 心肌TI在急性冠状动脉综合征时可升高，对心肌损伤敏感。     

心脏标志物检测在急性心肌梗死诊断中的临床意义

目的探讨心肌钙蛋白Ⅰ（cTnⅠ）、肌红蛋白（Mb）和肌酸激酶同工酶（CK-MB）在早期诊断急性心肌梗死（AMI）中的价值。方法对45例急性心肌梗死患者和40例体检正常者cTnⅠ、Mb和CK-MB进行检测,并行统计学分析。结果急性心肌梗死组血清cTnⅠ、Mb和CK-MB含量显著高于对照组。结论联合检测血清cTnⅠ、Mb和CK-MB的有助于早期诊断急性心肌梗死和病情分析。     

急性冠脉综合征患者血清高敏C反应蛋白及肌钙蛋白Ⅰ水平监测的意义

目的研究急性冠脉综合征（ACS）患者血清中高敏C反应蛋白（hs-CRP）及肌钙蛋白I（cTnI）的变化,探讨其在ACS危险分层中的作用。方法受试者共107例,稳定型心绞痛（SAP）35例、不稳定型心绞痛（UAP）42例、急性心肌梗死（AMI）30例,对照组40例,分别取血清测定hs-CRP、cTnI水平,比较各组的差异。结果AMI组血清hs-CRP和cTnI水平和其它组相比显著增高,差异有显著意义（p〈0.01）;UAP组血清hs-CRP、cTnI水平明显高于SAP组（p〈0.01）;SAP组与对照组相比差异无统计学意义（p〉0.05）。结论血清hs-CRP和cTn I浓度升高与ACS的发生,特别是AMI的发生有着密切的关系,血清hs-CRP和cTn I浓度升高可能是ACS,特别AMI发生的的预测指点标。联合评价这两项标志物的水平可以识别心脏高风险的病人。     

Evaluation of Myocardial Viability after Myocardial Infarction with Intravenous Real-time Myocardial Contrast Echocardiography

The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions： homogeneous opacification; partial or reduced opaciflcation or subendocardial contrast defect; contrast defect. The former two conditions were used as the standard to define the viable myocardium. The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction, including 47 segments of hypokinesis, 56 segments of akinesis and 6 segments of dyskinesis. The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification, 14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization. In our study, the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%, respectively. It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.     

磁共振心肌灌注成像评价心肌梗死PTCA治疗前后心肌存活

目的 评价磁共振心肌灌注成像(MRMPI) 检测心肌梗死存活心肌的作用. 方法 选择心肌梗死患者51 例.采用1.5 T MR扫描仪,反转恢复快速小角度激励( IR-turbo FLASH) 序列,全部患者均在静脉注射钆喷替酸葡甲胺(Gd-DTPA) 0.1 mmol/kg、MRMPI 首过期及5~30 min 延迟期成像.21 例行静息、负荷99锝单光子发射计算机体层摄影术( single photon emission computed tomography, SPECT) 进行对照研究.首过期行短轴面成像,延迟期行短轴面及长轴面成像.结果 51例心肌梗死患者,42 例(82.3%) 首过期显示灌注减低;50 例(98%) 延迟增强.在21例168个心肌段SPECT诊断无活性心肌段48个,MRMPI 示梗死区均有延迟增强,SPECT诊断存活心肌段120 个,MRMPI 示97段无延迟增强.以静息、负荷99m锝SPECT 作为参考标准,MRMPI 的敏感度、特异度分别为100%、80.8%. 结论 MRMPI 可有效地检测心肌梗死的存活和非存活心肌,以及其程度和范围.     

Acute myocardial infarction: myocardial salvage assessment

Primary coronary revascularization by means of percutaneous coronary intervention(PCI)is a highly effective treatment of acute myocardial infarction re-establishing coronary perfusion and stopping the ongoing necrosis in the dependent myocardium.Single-photon emission computed tomography(SPECT)is the most widely used modality assessing myocardial salvage as the difference between the acute perfusion defect before intervention and the remaining scar size measured in a second scan several days after the event.SPECT allows quantification of area at risk(AAR)and final infarct size(FIS)by tracer injection prior to revascularization and after 1 month,respectively.SPECT provides the most validated measure of myocardial salvage and has been utilized in multiple randomizedclinical trials.However,SPECT is logistically challenging,expensive,and includes radiation exposure.More recently,a large number of studies have suggested that cardiac magnetic resonance(CMR)can determine salvage in a single examination by combining measures of myocardial oedema in the AAR exposed to ischaemia reperfusion with FIS quantification by late gadolinium enhancement.     

Acute myocardial infarction due to myocardial bridge

Myocardial bridge (MB) is regarded as a common anatomic variant rather than a congenital condition anomaly,defined as the intramyocardial course of a portion of the coronary artery.It was first mentioned by Rayman in 1737 and first described by Grainicianu in the early 1920s.The current gold standard for diagnosing     

超声检测心内外膜下跨壁速度梯度在心肌缺血诊断中的应用

目的：探讨跨壁速度梯度（MVG）在诊断心肌缺血中的应用价值。方法：检测38例冠心病患者（病例组）和28例健康志愿者（对照组）心尖四腔观、两腔观各节段心肌收缩期跨壁速度梯度（MVG-L＋）、舒张期跨壁速度梯度（MVG—L-）。结果：对照组MVG—L＋和MVG—L-由基底段、中间段至心尖段差异无显著性意义。病例组缺血节段的MVG-L＋和MVG—L-较对照组相应节段明显降低。结论：MVG可定量评价局部心肌运动状态，为临床心功能评价提供有效指标。     

Relation of myocardial bridge to myocardial infarction: a meta-analysis

Background Small case series have suggested an association of coronary myocardial bridge （MB） with myocardial infarction （MI）.However,the relationship between MB and major adverse cardiac events （MACE） remains largely unknown.The aim of this study was to assess the relationship between MB and MACE involving MI.Methods We performed a systematic search of MEDLINE,PreMEDLINE,and all EMB Reviews as well as a reference list of relevant articles according to the SPICO （Study design,Patient,Intervention,Control-intervention,and Outcome） criteria using the following keywords：myocardial bridging,myocardial bridge,intramural coronary artery,mural coronary artery,tunneled coronary artery,coronary artery overbridging,etc.Bibliographies of the retrieved publications were additionally hand searched.Studies were included for the meta-analysis if they satisfied the following criteria：（1） they evaluate the association of MB with cardiovascular endpoint event; （2） they included individuals with MB and those without MB; 3） they excluded individuals with obstructive coronary artery disease （CAD）.Studies were reviewed by a predetermined protocol including quality assessment.Dates were pooled using a random effect model.Results Seven observational studies that followed 5 486 patients eligible for the enrolled criteria were included from 7 136 initially identified articles.The prevalence of MB was 24.8％ （1 363/5 486）.During 0.5-7.0 years of follow-up of this cohort of population,crude outcome rates were 8.0％ in the MB group and 7.7％ in the non-MB group.The odds ratio of overall MACE and MI were 1.34 （95％ confidence interval （CI）：0.57-3.17,P=0.51,n=7 studies） and 2.75 （95％ CI：1.08-7.02,P ＜0.03,n=5 studies） respectively for subjects of MB compared to non-MB.Conclusion Relationship between MB and MI appears to be a real one,although the study did not reveal a connection of MB to MACE,suggesting whether the necessity of antiplatelet therapy needs to be further studied in a larger cohort of patients with MB prospectively.     

心肌声学造影对急性心梗PCI术后心肌灌注的评价

目的:通过心肌声学造影(MCE)对急性心梗经皮冠状动脉支架术(PCI)后心肌灌注的情况进行判断,了解其对左心功能及左室重构的影响.方法:采用病例对照的研究方法,根据PCI术后1周的MCE检查,将急性心梗患者分为灌注正常组、灌注稀疏组和灌注缺失组,并随访检查3个月、6个月的左室射血分数(LVEF)及左室舒张末内径(LVDd)的变化情况,比较组内及组间不同时段LVEF与LVDd的变化.结果:PCI术后3个月灌注稀疏组LVEF恢复到正常;灌注缺损组PCI术后LVEF的平均水平随时间变化而逐渐降低;灌注缺损组患者的LVEF低于灌注稀疏组和灌注正常组(P<0.05);术后6个月灌注缺损组LVDd平均水平高于灌注正常组和灌注稀疏组(P<0.05),灌注缺损组随时间的变化左室内径逐渐增大(P<0.05).结论:急性心梗患者PCI术后心肌微循环较差时,其左室射血分数降低,左室内径增大;MCE有利于对急性心梗患者PCI术后左心功能及左室重构评估.     

超声心肌造影技术对心肌梗塞患者心肌微循环的定量评价

目的：探讨超声心肌造影技术在心肌梗塞(简称心梗)患者心肌微循环灌注改变中的应用价值。方法：对30例急性心梗患者进行超声心动图及心肌造影检查,观察患者梗塞区域(AMI组,同时以患者非梗塞区域为自身对照组)心肌微循环灌注并以CPS造影软件进行分析。结果：心肌梗塞患者梗塞区域心肌微循环灌注开始时间(AT)、达峰时间(APT)较同一切面内的非梗塞区域明显延长（P<0.05）,梗塞区域造影剂灌注的峰值强度(PI)及灌注速度(β)均明显低于同一切面内的非梗塞区域（P<0.05）。结论：超声心肌造影技术可以定量评价心梗患者心肌微循环灌注,具有重要的临床应用价值。     

急性心肌梗死心肌蛋白检测的临床评价

目的探讨心肌损伤标志物心肌蛋白检测在急性心肌梗死(AcuteMyocardialInfarction,AMI)诊断时的应用价值,减少急性心肌梗死漏诊、误诊发生率。方法测定35例AMI病人在发病的第4小时、8小时、24小时,5天等四个时间段的血清肌钙蛋白(IcTnI)、肌钙蛋白T(cTnT)及肌红蛋白(Mb)浓度,和对照组30例健康者体检时的血清相应项目数据对比并进行统计学处理。结果AMI患者发病后4￣8小时血清cTnI、cTnT开始上升,24小时达到峰值,5天仍维持在较高水平,其浓度以及阳性率与正常对照组比较均有显著性差异(P<0.05);而血清Mb在4￣8小时上升幅度更大,但24小时后浓度以及阳性率与正常对照组比较差异不显著(P>0.05)。结论在心肌梗死的早期诊断指标中,Mb的优势明显;cTnI、TnT可用于AMI的早期诊断,但更适用于那些因就诊时间较晚、心肌酶已正常的心梗病人。三者联测可更早、更可靠地提高心肌梗死诊断的准确率。