冠状动脉支架置入术肌钙蛋白Ⅰ的释放及相关临床因素

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(cTnI)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cTnI的释放及相关临床因素.方法61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、24小时检测磷酸肌酸激酶(CK)、CK-MB、cTnI,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＞200u/l,CKMB＞5.6ng/ml,cTnI＞1.5ng/ml为心肌损伤临界值.结果所有患者术前cTnI、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60例患者中术后cTnI及CK-MB均升高18例,cTnI升高而CK-MB正常19例,CK-MB升高而cTnI正常1例,CK-MB及cTnI均正常22例.术后cTnI升高组同cTnI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cTnI升高组发生率相对较高,但无显著性差异.cTnI及CK-MB均升高组的术后cTnI、CK-MB水平较cTnI升高、CK-MB正常组分别升高2.2、9.4倍.结论冠状动脉支架置入术有约60%的微小心肌损伤率,cTnI较CK-MB有更高的敏感性,cTnI及CK-MB均升高提示心肌损伤的程度更大.     

老年人冠脉支架置入术后肌钙蛋白T增高对左室射血分数的影响

目的　观察冠脉支架置入术后微小心肌损伤的发生率及其对左室射血分数的影响。方法　对 46例行冠脉内支架置入术 (支架组 )及2 2例行冠脉造影术 (造影组 )的患者术前、术后血液心肌钙蛋白 T(CTn T)及肌酸激酶 MB同工酶 (CK- MB)水平进行测定 ;支架组于术前及术后 4 w行核素左心室射血分数 (LVEF)测定。结果　支架组及造影组术后 CTn T增高的发生率分别为 2 1 .7% (1 0 / 4 6)及 0 % (0 / 2 2 ) ,差异有显著性 (P<0 .0 1 )。行支架置入术的患者中 ,CTn T(+)组术前、术后 LVEF分别为 (56.8± 9.9) %和 (58.8± 1 0 .2 ) % (P>0 .0 5) ;CTn T(- )组术前、术后 L VEF分别为 (58.1± 1 2 .1 ) %和 (68.7± 1 1 .6) % (P<0 .0 5)。同期两组比较 ,术后 CTn T阴性组 LVEF较 CTn T阳性组明显增高 (P<0 .0 5) ,术前两组LVEF无显著差别。结论　成功施行冠脉支架置入术后 ,部分患者出现微小心肌损伤 ,这影响着病人近期心功能的恢复。     

冠状动脉支架置入术后肌钙蛋白T增高的发生率及其原因分析

目的 :本研究检测冠状动脉 (冠脉 )内支架置入术 (CS)后肌钙蛋白 T(Tn T)增高的发生率 ,并探讨 Tn T增高的原因及其对短期预后的预测价值。　　方法 :对 5 1例行 CS(CS组 )及 34例行冠脉造影术 (CAG) (CAG组 )的患者术前、术后血液 Tn T及肌酸激酶 MB同工酶 (CK- MB)水平进行了测定。仔细分析所有患者的临床及术中情况 ,并密切观察住院期间是否发生严重冠脉事件 (如死亡、非致死性心肌梗塞等 )。　　结果 :CS及 CAG后 Tn T增高的发生率分别为 5 .9% (3/ 5 1)及 2 .9% (1/ 34) ,两者之间无显著差别 (P=0 .5 3)。行 CS的患者中 ,术后 Tn T增高的 3例患者支架置入处均有分支血管闭塞 ,其中 2例术前 Tn T已高于正常。术后 Tn T增高与不增高者之间 ,CK- MB增高的发生率无显著差别 (P>0 .0 5 )。住院期间均无严重冠脉事件发生。　　结论 :CS后 Tn T增高的发生率很低 ;术后 Tn T增高与支架置入处分支血管闭塞、术前近期已有微小心肌损伤等有关。术后 Tn T增高对住院期间严重冠脉事件的发生可能无预测价值。     

冠状动脉介入治疗对冠心病患者肌钙蛋白I及血管性血友病因子的影响

目的研究冠状动脉支架植入术对冠心病患者血中心肌肌钙蛋白I(cTnI)及血管性血友病因子(vWF)水平的影响。方法选择冠状动脉支架植入术患者110例为试验组;20例冠状动脉造影结果阳性,但未能进行介入治疗的患者作为对照组。术前和术后24 h检测cTnI和vWF。结果试验组术前和术后的cTnI值分别为(0.04±0.03)μg/L和(0.10±0.04)μg/L,两者比较差异有统计学意义(P<0.05),而对照组术前和术后的cTnI值比较差异无统计学意义(P>0.05)。试验组术前和术后的vWF水平分别为(123.75±32.77)%和(175.35±36.90)%,两者比较差异有统计学意义(P<0.05)。对照组vWF水平手术前后比较,差异无统计学意义(P>0.05)。而术后vWF水平及cTnI值试验组高于对照组,两组比较差异有统计学意义(P<0.05)。试验组术后cTnI与vWF呈线性相关(r=0.80,P<0.05)。结论冠状动脉支架植入术后血cTnI和vWF值升高,提示有心肌的微小损伤及血管内皮损伤的存在。     

冠状动脉支架置入术后肌钙蛋白Ⅰ变化的临床意义

目的 :探讨冠状动脉 (冠脉 )支架置入术后肌钙蛋白Ⅰ的变化、预后意义和相关因素。方法 :76例行择期冠脉支架置入术且术前肌钙蛋白Ⅰ正常的患者 ,监测术前 ,术后 12、2 4h肌钙蛋白Ⅰ ,观察 6～ 12个月内主要心血管事件。结果 :76例中出现术后肌钙蛋白Ⅰ升高 2 8例 (36 .84 % )。在 6～ 12个月随访中术后肌钙蛋白Ⅰ升高组和正常组主要心血管事件发生差异无统计学意义 ,但升高组住院期间再发心肌缺血高于正常组 (10 / 2 7∶7/4 4 ,P <0 .0 5 )。且均为肌钙蛋白Ⅰ峰值大于该组平均峰值者。多元逻辑回归分析示球囊扩张总时间和不稳定型心绞痛与肌钙蛋白Ⅰ升高有关。结论 :择期冠脉支架置术后肌钙蛋白Ⅰ可升高。术后肌钙蛋白Ⅰ升高者近期再发心肌缺血增加。术后肌钙蛋白Ⅰ升高和中期随访时心脏事件发生未见明显关系 ,但与球囊扩张总时间及不稳定型心绞痛有关     

直接冠状动脉支架置入术的临床应用

冠状动脉内支架置入术在冠心病介入治疗中应用最为广泛 ,冠状动脉内支架置入一般先对靶病变部位用球囊进行预扩张 ,然后再置入支架。近年来 ,由于支架置入技术和球囊预装支架设计的改进 ,临床医师对一些选择的病变开始试用直接支架置入术 ,在支架置入前不用球囊预先扩张冠状动脉狭窄部位〔1 ,2〕。我们对 42例患者进行了直接冠状动脉支架置入术 ,现总结报告如下。1　对象与方法选自 1 998年 7月～ 2 0 0 1年 5月在我院住院治疗的 42例冠心病患者 ,入选标准为〔1～ 3〕:①病变无钙化或轻度钙化 ;②病变长度 <2 5ｍｍ ;③血管直径≥ 2 .5ｍｍ …     

心肌肌钙蛋白Ⅰ在临床上的应用

心肌肌钙蛋白I(cTnI)为心肌细胞所特有,当心肌损伤时,cTnI快速释放入血循环,测定其浓度已成为心肌损伤特异性标志物,不仅敏感性高,特异性强,且持续时间长。     

冠状动脉支架置入术后支架内再狭窄的相关因素分析

目的分析冠心病患者冠状动脉支架置入术(PCI)后支架内再狭窄的相关因素。方法收集我院成功行PCI并于术后1 a行冠状动脉造影随访的患者797例,以支架置入段内径狭窄≥50%为再狭窄,分为再狭窄组153例和无狭窄组644例。回顾性分析两组患者的临床资料、生化指标及冠状动脉造影结果的差异,采用多因素Logistic分析其与冠状动脉支架内再狭窄的关系。结果再狭窄组糖尿病患病率为34.64%,高于无狭窄组的23.91%(P<0.01),支架直径为(2.90±0.41)mm,小于无狭窄组的(3.02±0.90)mm(P<0.01),血清尿酸为(406.54±78.18)μmol/L,高于无狭窄组的(343.78±76.64)μmol/L(P<0.01),血清总胆红素水平为(11.70±4.71)μmol/L,低于无狭窄组的(13.16±6.43)μmol/L(P<0.01)。多因素Logistic分析显示,糖尿病(OR=2.340,95%CI 1.893～3.011)、尿酸(OR=1.653,95%CI 1.447～2.083)、支架直径(OR=0.668,95%CI 0.496～0.898)、血清总胆红素浓度水平(OR=0.838,95%CI 0.797～0.980)与冠状动脉支架内再狭窄有关(P均<0.01)。结论糖尿病、支架直径、尿酸、总胆红素为冠状动脉支架置入术后支架内再狭窄的相关因素。其中糖尿病、高尿酸血症为冠状动脉支架内再狭窄的危险因素,较大支架直径、正常范围内较高水平的血清总胆红素为冠脉支架内再狭窄的保护因素。     

直接冠状动脉支架置入术的临床应用及影响因素

目的 探讨选择性直接冠状动脉支架置入术应用的可行性及影响因素。方法 对237例直接支架置入术患的病变特点及临床预后了分析,并与367例预扩张后支架置入术患进行了比较。结果 对筛选的254例患尝试直接支架置入术,237例（93．4％）获成功,其中A型病变52．7％,B1型病变40．1％,17例（6．7％）直接支架置入术失败,其中血管内超声肯定的钙化病变7例,斑块纤维化4例,血管严重成角6例（血管多个弯曲＞45度）。结论 对有经验的心脏介入医生筛选的病变,并避开钙化病变,严重成角血管和长病变,可考虑行直接冠状动脉动脉支架置入术。     

Successful coronary sinus lead placement after stenting of coronary vein stenosis.

In this paper, we describe a 62-year-old man with ischemic cardiomyopathy who underwent biventricular pacing and left ventricular lead could be implanted after stenting of a coronary vein stenosis.     

糖尿病酮症酸中毒非急性心肌梗死相关肌钙蛋白I升高二例报道

报道2例非急性心肌梗死(AMI)相关肌钙蛋白I(cTnI)升高的DKA患者。DKA是内分泌科常见急危重症,病情变化迅速,死亡率高。DKA与非AMI引起心肌损伤导致相关cTnI升高的研究较少,主要不良心血管事件发生率高,长期预后不佳。应对其鉴别以避免误诊并加强后续心脏评估。     

Factors associated with the release of cardiac troponin T following percutaneous transluminal coronary angioplasty

Background: Recent studies have suggested that immunoassay of cardiac troponin T (cTnT) provides a more sensitive measurement of myocardial necrosis than creatine kinase MB (CK-MB) mass concentration. Hypothesis: The purpose of this study was to compare the release of cTnT and CK-MB isoenzyme in patients undergoing percutaneous coronary angioplasty, and to investigate the clinical, procedural, and angiographic correlates of abnormal elevations of both of these markers. Methods: Total creatine kinase (total CK), CK-MB, and cTnT levels were measured immediately before and 12 h following intervention in 110 patients, including 100 consecutive patients undergoing coronary angioplasty and 10 control patients undergoing diagnostic cardiac catheterization. All patients had normal levels of all three markers at baseline. A postintervention total CK level >225 U/l, an increase in CK-MB >5.0 ng/ml, and/or an increase in cTnT >0.04 ng/ml were considered indicative of myocardial injury. Results: Coronary angioplasty was successfully performed in all 100 patients without emergency bypass surgery or death, although six patients required emergent placement of an intra-coronary stent for threatened closure. Eight patients demonstrated an abnormal increase in total CK, including six who were undergoing primary angioplasty for an acute myocardial infarction. One of these patients sustained a Q-wave infarction. Post angioplasty, 18 patients had elevations of both CK-MB and cTnT, 23 had elevations of only cTnT, and the remaining 59 patients had elevations of neither. All patients with CK-MB elevation also had cTnT elevation. Neither serologic marker increased in the diagnostic catheterization control patients. In comparison with patients without postintervention cTnT rise, patients with abnormal cTnT levels had a higher incidence of complex lesion morphology (p<0.01) and intra-coronary thrombus (p ≤0.0001) prior to coronary angioplasty, and a higher incidence of coronary dissection (p≤0.01), abrupt closure (p≤0.05), and side-branch occlusion (p≤0.01) during angioplasty. In patients with elevation of both cTnT and CK-MB, postintervention CK-MB levels were 12-fold higher and cTnT levels were 21-fold higher than in patients with isolated elevation of only cTnT (p<0.01). Conclusions: These data indicate that >40% of patients undergoing coronary angioplasty have evidence of minor degrees of myocardial damage, as evidenced by cTnT release. High-risk coronary lesions and both minor and major complications of angioplasty are associated with cTnT release. cTnT appears to be a more sensitive marker of myocardial injury than CK-MB under these circumstances. In comparison with isolated cTnT rise, elevation of both CK-MB and cTnT may be indicative of greater levels of myocardial injury.     

Hyperfibrinogenemia increases the risk of cardiac events after coronary artery stenting

Primary success rates, and the angiographic and clinical outcome after percutaneous coronary intervention, are influenced by many different factors. Clinical features and morphologic characteristics of the target lesion are important. Also, interventionally caused endothelial trauma may trigger atherogenetic and procoagulatory factors leading to intraluminal thrombosis. The study population consisted of 228 consecutive, unselected patients with symptomatic coronary artery disease or exercise-induced myocardial ischemia and coronary artery stenoses eligible for percutaneous intervention. We analyzed different clinical, morphological, and laboratory (total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, fibrinogen) features in those patients with adverse cardiac events (stent thrombosis, myocardial infarction, urgent target vessel revascularization, death) after primary successful coronary artery stenting, compared with a control group without adverse events. In the group with adverse cardiac events we found a significantly higher level of fibrinogen compared with the control group. Other laboratory data and clinical characteristics were not significantly different between the two groups. The study shows a possible association between hyperfibrinogenemia and adverse cardiac events after intracoronary stenting. In clinical practice, the potential role of elevated levels of fibrinogen in an unfavorable outcome after percutaneous coronary interventions should be considered when planning coronary artery stenting. Received: November 24, 2000 / Accepted: May 11, 2001     

冠状动脉支架术后血浆肌钙蛋白I对预后的影响

目的探讨不稳定性心绞痛患者经皮冠状动脉介入术(PCI)后血浆肌钙蛋白I(cTnI)对预后的预测价值。方法选择172例单支病变接受PCI术的不稳定性心绞痛患者,术后24h抽取静脉血化验cTnI,观察12～25个月的严重心脏不良事件。结果术后cTnI升高组(n=51)的严重心脏不良事件明显高于术后cTnI正常组(17.65%vs7.44%,P<0.05),cTnI升高组的血脂水平、他汀类药物、植入支架枚数、球囊预扩张时间、术前hsCRP水平与cTnI正常组比较,差异有统计学意义。结论cTnI的升高对PCI术后患者的预后有着重要的影响,尽早、足量的他汀类药物以及关注炎症的相关指标可使病人获益更大。     

心电积分图判定心肌缺血、心脏康复、冠脉支架术后再狭窄的临床应用

目的 :探讨心电积分图对于判断心肌缺血、冠脉支架术后冠脉再狭窄及心脏康复效果的临床应用。方法 :采用心电积分图对 37例临床拟诊冠心病及 14例冠脉支架术后患者进行检测 ,并与冠状动脉造影相对照。结果 :心电积分图判定心肌缺血的总准确率为 78.4 % ,敏感性为 72 .7% ,特异性为 80 .8% ;判定支架术后患者冠脉再狭窄的准确率为 6 4 .3%。结论 :心电积分图是一种判定心肌缺血较敏感的无创性方法 ,可用于评价心脏康复的疗效 ;它对判定支架术后冠脉再狭窄亦有一定参考价值。     

存活心肌对心脏事件的影响

目的 探讨冠心病患者有无存活心肌(VM)和是否血管重建术(RV)对心脏事件的影响。方法 本文研究了43例心肌梗死患者,均进行多巴酚丁胺负荷-再分布-再注射~(201)Tl心肌显像及冠状动脉造影。23例经心肌显像证实有VM者且接受RV,为RV组。另20例VM者未进行RV,为NRV组。对43例患者进行(11.8±2.1)月(5.5～15月)的随访,统计两组心脏事件的发生情况。结果 RV组23例患者中心脏事件发生率明显低于NRV组的20例患者心脏事件发生率,分别为13.0％(3/23)和40.0％(8/20)(P<0.05)。结论 存活心肌的检测对预测心脏事件的发生具有重要的意义。     

直接冠状动脉支架置入的疗效观察

目的观察直接冠状动脉支架置入术的可行性和安全性。方法选择80例冠心病患者不作冠状动脉预扩张直接行支架置入,分析疗效和成功率。结果80例患者中有90处病变(置入支架),不预扩张成功置入85个支架,成功率为94％,有3处(3％)病变支架不能通过,经预扩张后再次成功置入,1个(1％)支架脱载。无其他并发症发生。结论在选择的冠心病患者中,不做预扩张直接冠状动脉支架置入是安全可行的。