心肌肌钙蛋白I测定评价窒息新生儿心肌损害的临床价值

目的　探讨心肌肌钙蛋白Ｉ（ＣＴｎＩ）评估窒息新生儿心肌损害的临床价值。方法　放射免疫法测定窒息新生儿组３７ 例（ 轻度窒息１９ 例,重度窒息１８ 例）、对照组１０ 例,生后２４ 小时、３ 天、７ 天、１４ 天血清ＣＴｎＩ水平。结果　窒息组２４ 小时、３ 天、７ 天ＣＴｎＩ值明显高于对照组（ Ｐ＜０－０５）,且ＣＴｎＩ水平与窒息严重程度呈正相关,窒息组治疗前后对比呈逐渐下降趋势。其中重度窒息组９ 例,Ｈｏｌｔｅｒ 示明显ＳＴ－ Ｔ 段改变者,其血清ＣＴｎＩ升高更明显。结论　ＣＴｎＩ的测定有助于早期预测心功能损害。     

新生儿窒息后心肌肌钙蛋白Ⅰ与心肌酶活性的时相变化及其意义

目的：探讨新生儿窒息后心肌肌钙蛋白Ⅰ(CTnⅠ)及心肌酶活性的时相变化。方法：化学发光法和全自动生化分析仪测定新生儿窒息组26例(轻度窒息16例，重度窒息10例)和对照组10例生后0 h，6 h，12 h，24 h，72 h，10 d血清CTnI水平、肌酸激酶(CK)、肌酸激酶心型同工酶(CK-MB)、乳酸脱氢酶(LDH)及天门冬酸氨基转移酶(AST)活性。结果：窒息组0 h血清CTnI水平，CK，CK-MB和LDH活性明显高于对照组，均P<0.01；其中CTnI峰值在12 h，48 h开始下降；CK活性峰值为6 h，而CK-MB活性于12～24 h达高峰，均于72 h后下降；LDH活性于12 h达高峰，AST活性则于6 h开始升高，24 h后降低。结论：窒息新生儿生后早期动态监测血清CTnI与心肌酶活性有助于及时诊断和治疗心肌损害。     

新生儿窒息后心肌损害的心电图研究

采用心电图方法对58例窒息新生儿进行研究,发现窒息后早期心电图异常发生率为39.7%,其中以广泛T波低平或倒置(18例)、ST段移位(9例)和Q-T间期延长(6例)为主要表现。其他异常包括窦性心动过缓(3例)、窦性心动过速(2例)、右房肥大(2例)、右室肥大(2例)、P-R间期延长(1例)和异常Q波(1例),这些少见改变大多同时合并ST-T异常。心电图异常组的心衰发生率和病死率均较高。对存活者随访表明:7～10天心电图异常消失;38天～15个月无再出现新的异常。     

窒息新生儿心肌肌钙蛋白Ⅰ测定及临床分析

目的 通过测定窒息新生儿心肌肌钙蛋白Ⅰ（cTnⅠ），探讨其与新生儿窒息及窒息后心肌损害的关系。方法 采用胶乳增强免疫比浊法测定48例轻度窒息儿，42例重度窒息儿，40例健康新生儿（对照组）血清cTnⅠ浓度，同时行心电图检查。结果 两组窒息儿血清cTnⅠ浓度均明显高于对照组（P〈0．01），重度窒息组高于轻度窒息组（0．01〈P〈0．05）。结论 cTnⅠ浓度与新生儿窒息程度密切相关：窒息越重，cTnⅠ值越高，心肌损害越严重。应常规检测窒息新生儿的cTnⅠ．以及时治疗．改善预后。     

心肌肌钙蛋白I对新生儿窒息心肌损害的早期诊断价值

目的评价心肌肌钙蛋白I（cTn I）对新生儿窒息心肌损害（MCI）的早期诊断价值。方法采用双抗夹心免疫测定方法检测51例生后窒息并MCI新生儿（MCI组）血清cTnI和CK．MB水平，并以57例窒息无MCI（NMCI组）及45例正常新生儿（NC组）作为对照组。结果NC组cTnI水平在生后7d内无变化，MCI组生后24h内和1周时cTnI水平均显著高于NMCI组和NC组（P〈0．01）。MCI组生后24h内CK—MB水平显著高于NMCI组和NC组（P〈0．01）；生后5—7d3组CK—MB水平差异无显著性（P〉0．05），且均明显低于生后24h内水平。cTnI诊断新生儿MCI的敏感度为91％，特异度为88％，准确度89％；CK—MB的敏感度为86．3％，特异度为69％，准确度为74％。结论血清cTnI及CK-MB均可用于新生儿窒息MCI的早期诊断，cTnI优于CK-MB。     

心肌肌钙蛋白Ⅰ对新生儿窒息心肌损害的早期诊断价值

目的 评价心肌肌钙蛋白Ⅰ(cTn Ⅰ)对新生儿窒息心肌损害(MCI)的早期诊断价值.方法 采用双抗夹心免疫测定方法检测51例生后窒息并MCI新生儿(MCI组)血清cTn Ⅰ和CK-MB水平,并以57例窒息无MCI(NMCI组)及45例正常新生儿(NC组)作为对照组.结果 NC组cTn Ⅰ水平在生后7 d内无变化,MCI组生后24 h内和1周时cTn Ⅰ水平均显著高于NMCI组和NC组(P＜0.01).MCI组生后24 h内CK-MB水平显著高于NMCI组和NC组(P＜0.01);生后5～7 d 3组CK-MB水平差异无显著性(P＞0.05),且均明显低于生后24 h内水平.cTn Ⅰ诊断新生儿MCI的敏感度为91%,特异度为88%,准确度89%;CK-MB的敏感度为86.3%,特异度为69%,准确度为74%.结论 血清cTn Ⅰ及CK-MB均可用于新生儿窒息MCI的早期诊断,cTn Ⅰ优于CK-MB.     

窒息新生儿心肌损害的早期诊断

目的探讨血清肌酸磷酸激酶同工酶(CK-MB)及心肌肌钙蛋白Ⅰ(cTnⅠ)对新生儿(MCI组)窒息心肌损害(MCI)的早期诊断价值。方法采用直接化学发光免疫夹心法和免疫抑制酶动力学法动态检测34例生后10 d内窒息并MCI新生儿(MCI组)血清cTnⅠ和CK-MB水平,并以38例窒息无心肌损害(NMCI组)及30例正常新生儿(NC组)作为对照组。结果NC组cTnⅠ水平在生后10 d内无变化,MCI组生后24 h内和1周时cTnⅠ水平均显著高于NMCI组和NC组(P均<0.01)。MCI组生后24 h内CK-MB水平显著高于NMCI组和NC组(P均<0.01);3组生后5~7 d检测值比较均无统计学差异(P均>0.05),且均明显低于生后24 h内水平。cTnⅠ诊断新生儿MCI的敏感度为91%,特异度为88%,准确度89%;CK-MB诊断新生儿MCI敏感度为85%,特异度为68%,准确度为74%。结论血清CK-MB及cTnⅠ均可用于新生儿窒息心肌损害的早期诊断,cTnⅠ优于CK-MB。     

血清肌酸磷酸激酶同工酶及心肌肌钙蛋白早期诊断窒息新生儿心肌损害

目的　探讨血清肌酸磷酸激酶同工酶 (CK- MB)及心肌肌钙蛋白I(cTnI)测定对窒息新生儿心肌损害的早期诊断价值。方法　窒息组 40例 (轻度窒息、重度窒息各 2 0例 )、对照组 2 0例 ,生后 1、5、1 0d测定血清CK MB及cTnI水平。结果　窒息组生后 1d血清CK- MB及cTnI明显高于对照组 (P均 <0 .0 1 ) ,重度窒息组明显均高于轻度窒息组 (P均 <0 .0 1 ) ,治疗后呈逐渐下降趋势。血清CK- MB及cTnI对心肌损害诊断的敏感性无显著差异 (P >0 .0 5)。结论　血清CK MB及cTnI可用于窒息新生儿心肌损害的早期诊断。     

血清心肌肌钙蛋白Ⅰ诊断川崎病急性期心肌损伤的临床价值

为探讨血清心肌肌钙蛋白Ⅰ(cTnI)诊断川崎病(KD)急性期心肌损伤的临床价值。检测KD组(n=40)及对照组(n=23)患儿血清cTnI、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、乳酸脱氢酶(LDH)与谷草转氨酶(GOT)浓度。结果显示:①KD组与对照组血清CK、LDH、GOT浓度无显著性差别(P>0.05);而血清cTnI,CK-MB浓度明显高于对照组水平(P<0.001)。②在诊断KD患儿急性期心肌损伤上cTnI优于CK-MB(P<0.05),。结果表明:cTnI与CK-MB对KD患儿急性期心肌损伤有诊断价值;与CK-MB比较,cTnI具有高特异性、灵敏度。     

心脏直视术后心肌肌钙蛋白Ⅰ的转归及其影响因素相关性分析

目的探讨心脏直视术后心肌肌钙蛋白Ⅰ(TnTi)的转归,并就其与各影响因素作相关性分析。方法收集57例中低温体外循环下行心内畸形纠治术后患儿,年龄(2.34±2.11)岁.体重(10.92±4.59)kg。按病种不同分为A组(法洛氏四联症组,n=31)和B组(室间隔缺损组,n=26)。分别测定术前、主动脉开放5min、6h、12h、24h、48h、72h7个时相点血清TnTi浓度和心功能评分(score),记录体外转流时间(TT)、主动脉阻断时间(CT)以及监护窒预后情况。结果①与术前相比,主动脉开放5min时TnTi显著升高达到峰值(P<0.01),72h后仍高于术前水平(P<0.01);A组患儿血清TnTi显著高于B组患儿,两组cTnTi峰值分别是术前的118和55倍。②患儿TT、CT、手术机械损伤部位及程度与TnTi浓度呈正相关,相关系数分别为0.51、0.51、0.35(P均<0.01)。score与TnTi浓度呈负相关,相关系数为-0.52(P<0.01)。③2.3μg／L是预估患儿术后心功能恢复以及指导临床治疗的临界值。结论TnTi是心脏直视术后评价心肌受损的可靠指标,对反映患儿术后心功能的恢复有一定参考价值。     

窒息新生儿血清肌钙蛋白I和磷酸肌酸激酶同工酶变化的意义

目的探讨血清肌钙蛋白I(cTnI)和磷酸肌酸激酶同工酶(CK-MB)对窒息新生儿心肌损伤的早期诊断价值。方法选择轻度窒息新生儿29例(轻度组)、重度窒息新生儿18例(重度组)。采用ELISA法和酶动力法检测新生儿血清cTnI水平和CK-MB活性。结果出生d1窒息新生儿血清cTnI和CK-MB水平在轻度组[(2.25±0.54)μg/L、(223.4±23.5)U/L]和重度组[(4.25±0.83)μg/L、(256.3±21.8)U/L]均显著高于对照组(Pa<0.01);重度组血清cTnI和CK-MB水平均显著高于轻度组(Pa<0.01)。治疗后d7窒息新生儿血清cTnI和CK-MB水平均明显下降,轻度组[(0.69±0.18)μg/L、(151.4±18.4)U/L]与对照组均无显著差异(Pa>0.05),重度组[(1.54±0.72)μg/L、(188.9±21.5)U/L]显著高于轻度组和对照组(Pa<0.01)。结论窒息新生儿伴心肌损伤时血清cTnI和CK-MB水平升高;动态观察可用于窒息新生儿微小心肌损伤的早期诊断。     

Troponin-T levels in perinatally asphyxiated infants during the first 15 days of life

Aim: To measure serial cardiac troponin‐T, creatine kinase, creatine kinase‐MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase levels in asphyxiated newborn infants during the first 15 d of life. Methods: Troponin‐T, creatine kinase, creatine kinase‐MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase (LDH) concentrations were measured prospectively in blood samples obtained from 45 asphyxiated and 15 healthy term neonates within the first 2–4 h, third, seventh and 15th days. Results: Infants with severe asphyxia had significantly higher cardiac troponin‐T levels than grade I and II asphyxiated and healthy neonates within the first 2–4 h of life (0.34 ± 0.21 ag/ml vs 0.07 ± 0.03 ag/ml, 0.12 ± 0.07 ag/ml, 0.04 ± 0.02 ag/ml, respectively). Troponin‐T levels remained high on days 3 and 7 in severely asphyxiated neonates. The creatinine kinase‐MB levels were significantly higher in grade II and III asphyxiated neonates than grade I asphyxiated and healthy neonates within the first 2–4 h. No difference was found in creatinine kinase‐MB on day 3. There was cardiac involvement in 12 (80%) newborns of group III on B mode echocardiographic images on day 1. However, no echocardigraphic pathology was found in the seventh‐ and 15th‐day echocardiographic analysis in any groups. Conclusion: Our results suggest that asphyxia‐related cardiac changes were significant but reversible in severely asphyxiated neonates, and troponin T is a good determinant of the degree of injury to the heart within the first week of life. Cardiac troponin T also has a wider diagnostic frame than other diagnostic markers of myocardial damage.     

糖原磷酸化酶同功酶脑型在新生儿窒息合并心肌损伤中的变化及其相关因素

目的探讨糖原磷酸化酶同功酶脑型(glycogen phosphorylase isoenzyme BB,GPBB)在新生儿窒息合并心肌损伤中的变化及与各种围生因素的相关性。方法随机选择64例窒息患儿为研究对象(轻度窒息39例,重度窒息25例;心肌损伤30例,非心肌损伤34例),以25例正常新生儿为对照组。采用酶联免疫吸附法(ELISA)测定血浆GPBB水平,同时检测心肌酶、肌钙蛋白I、心电图、X线胸片等。结果心肌损伤患儿血浆GPBB(13.84,7.57ng/ml)明显高于非心肌损伤组(4.97,3.24ng/ml)和对照组(4.95,1.99ng/ml)(P<0.01)。GPBB、cTnI、CK-MB诊断心肌损伤的敏感性分别为90%、66.7%、83.3%,GPBB的敏感性优于cTnI(χ2=4.812,P<0.05),与CK-MB比较差异无统计学意义(χ2=0.577,P>0.05);GPBB、cTnI、CK-MB诊断心肌损伤的特异性分别为88.2%、91.2%、67.6%,GPBB的特异性优于CK-MB(χ2=4.191,P<0.05),与cTnI比较差异无统计学意义(χ2=0.159,P>0.05)。...     

窒息新生儿血清肌钙蛋白I和磷酸肌酸激酶

目的探讨血清肌钙蛋白I（cTnI）和磷酸肌酸激酶同工酶（CK—MB）对窒息新生儿心肌损伤的早期诊断价值。方法选择轻度窒息新生儿29例（轻度组）、重度窒息新生儿18例（重度组）。采用ELISA法和酶动力法检测新生儿血清cTnI水平和CK—MB活性。结果出生d1窒息新生儿血清cTnI和CK-MB水平在轻度组[（2．25±0．54）μg／L、（223．4±23．5）U／L]和重度组[（4．25±0，83）μg／L、（256．3±21．8）U／L]均显著高于对照组（Pα〈0．01）；重度组血清cTnI和CK-MB水平均显著高于轻度组（Pα〈0．01）。治疗后d7窒息新生儿血清cTnI和CK—MB水平均明显下降，轻度组[（0．69±0．18）μg／L、（151．4±18．4）U／L]与对照组均无显著差异（Pα〉0．05），重度组[（1．54±0．72）μg／L、（188．9±21．5）U／L]显著高于轻度组和对照组（Pα〈0．01）。结论窒息新生儿伴心肌损伤时血清cTnI和CK—MB水平升高；动态观察可用于窒息新生儿微小心肌损伤的早期诊断。     

Serial evaluation for myocardial performance in fetuses and neonates using a new Doppler index

BACKGROUND: Fetal echocardiography has been used for non-invasive evaluation of human fetal cardiac anatomy, function and hemodynamics. The Tei index, a new Doppler index known to be independent of both ventricular geometry and heart rate, has recently been applied to the evaluation of myocardial performance. METHODS: In the present study, the Tei index was prospectively and longitudinally determined in 50 normal fetuses, 35 fetuses with intrauterine growth retardation (IUGR), 30 fetuses of diabetic mothers (DM) and 20 normal infants. The Tei index of both left and right ventricles was calculated from a Doppler ventricular inflow and outflow trace using the following formula: Tei index = (ICT + IRT)/ET, where ICT is isovolumetric contraction time; IRT, isovolumetric relaxation time; and ET, ejection time). RESULTS: The Tei index of the left ventricle decreased linearly with advancing gestational age during 18-33 weeks and decreased acceleratively with increasing gestational age after 34 weeks. The index of the right ventricle decreased slightly and linearly with advancing gestational age during 18-41 weeks. In neonates, the Tci index of the left and right ventricle increased immediately and transitorily after birth and decreased and stabilized after 24 h of life. From 18 to 26 weeks of gestation, the Tei indices in fetuses with IUGR and of DM were not significantly different from controls. However, from 27 to 40 weeks of gestation, the Tei indices in both fetuses with IUGR and of DM were significantly greater than controls. CONCLUSIONS: This gradual decrease in the Tei index during gestation may represent the maturational or developmental alternation of myocardial performance in utero. Fetuses with IUGR and of DM may have abnormal myocardial performance in later gestation.