心肌肌钙蛋白T及其在某些心脏疾患中的应用

心肌肌钙蛋白（ｃＴｎＴ）作为心肌肌钙蛋白的一种亚型，在血清中的浓度变化与某些心脏疾患的诊断、病情危重程度的评从及预后的判断有密切关系，并在其中的某些方面已成为一种独立的生化指标，对临床诊断和治疗具有明确指导意义。有关它的检测方法也相应得到了发展和创新，但它的理化特性及临床应用尚存在未明确的部分，值得进一步研究。     

心肌肌钙蛋白Ⅰ的临床应用及检测方法进展

cTnI(心肌肌钙蛋白Ⅰ)是心肌肌钙蛋白的一种亚型，正常人血液中含量很低，当心肌细胞损伤时，cTnI在血液中的含量迅速升高。近年来随着cTnI检测方法的不断改进，cTnI已成为最具有临床价值的心肌损伤标志物之一，被广泛应用于心脏疾患的临床诊断和检测。     

心肌肌钙蛋白Ⅰ的临床应用及检测方法进展

cTnI(心肌肌钙蛋白Ⅰ)是心肌肌钙蛋白的一种亚型,正常人血液中含量很低,当心肌细胞损伤时,cTnI在血液中的含量迅速升高。近年来随着cTnI检测方法的不断改进,cTnI已成为最具有临床价值的心肌损伤标志物之一,被广泛应用于心脏疾患的临床诊断和检测。     

心肌肌钙蛋白I的临床应用及检测方法进展

cTnI(心肌肌钙蛋白I)是心肌肌钙蛋白的一种亚型,正常人血液中含量很低,当心肌细胞损伤时,cTnI在血液中的含量迅速升高。近年来随着cTnI检测方法的不断改进,cTnI已成为最具有临床价值的心肌损伤标志物之一,被广泛应用于心脏疾患的临床诊断和检测。     

心脏手术患者心肌肌钙蛋白I的变化及临床意义

心脏病是危害健康的一种重要疾病，在诸多诊断心脏病的临床生化指标中，磷酸肌酸激酶(CK)及同工酶(CK—MB)曾一度被认为是诊断心肌损伤的最好标志物，近年来的研究表明，肌钙蛋白I(CTnI)在诊断心肌组织损伤的特异性和敏感性方面，优于CK、CK-MB。本研究通过监测心脏手术患者CTnI、CK、CK—MB在血清中的含量，旨在探讨CTnI在心脏手术患者中的临床诊断价值及意义。     

心肌肌钙蛋白T用于诊断心血管病的研究进展

心肌肌钙蛋白Ｔ(ｃＴｎＴ)是近年来发展起来的一种高灵敏度、高特异性的心肌损伤血清标志物。目前 ,在冠心病包括急性心肌梗死 (ＡＭＩ)、不稳定心绞痛 (ＵＡＰ)、小灶性心肌梗死 (ＭＭＩ)及其他心肌损伤的诊断、病情程度估计和预后判断中已得到较广泛的应用。1　心肌肌钙蛋白Ｔ的生物学特征肌钙蛋白 (Ｔｎ)是一条单多肽链 ,由ＴｎＩ ,ＴｎＴ和ＴｎＣ三种亚单位组成。三者与原肌球蛋白一起构成Ｔｍ Ｔｎ复合体 ,调节肌肉收缩和舒张的力量和速度[1] 。其中ＴｎＴ在心肌和骨骼肌中由不同基因表达 ,有独特的氨基酸序列。对心肌ＴｎＴ特异反应的…     

血清心肌肌钙蛋白Ⅰ在心脏手术后的应用价值

心肌肌钙蛋白Ⅰ广泛应用于多种心肌损伤疾病的诊断。心肌细胞损伤后,细胞内的组成成分渗入外周血循环,使得心肌肌钙蛋白Ⅰ的检测成为可能。心脏手术过程是一个心肌细胞损伤的过程。我们选取微创冠脉搭桥及心脏换瓣两组对心肌损伤程度不同的心脏手术以及对照组(胸外科手术)中检测术前以及术后不同时间部分心肌肌钙蛋白Ⅰ(cTnI)的浓度,观察心肌肌钙蛋白Ⅰ在不同心肌损伤程度的心脏手术中的变化情况。现将结果报告如下。     

心肌肌钙蛋白Ⅰ对心肌损伤的诊断价值

目的　探讨心肌肌钙蛋白Ⅰ (cTnI)对心肌损伤的诊断和鉴别诊断价值。方法　对 1 5例确诊急性心肌梗死 (AMI)和 1 5例诊断明确的单纯肌酸磷酸激酶 (CK)增高无心肌损伤患者同一份血样分别行cTnI和CK、肌酸磷酸激酶同功酶(CK MB)测定。结果　cTnI在AMI组阳性率为 1 0 0 % ,对照组阳性为 0 ,两组差异非常显著 (P <0 .0 0 1 )。CK MB在AMI阳性率为 93 3 % ,对照组阳性率为 80 % ,两组相比无显著差异。结论　cTnI对心肌损伤具有很重要的诊断价值。     

血清心肌肌钙蛋白T的含量与心肌损伤的关系

目的　观察血清心肌肌钙蛋白T(cTnT)在心肌损伤后的含量变化。方法　制备家兔钝性胸部创伤模型 ,致成心肌损伤分别在伤前、伤后 4,8和 2 4h抽血测定cTnT含量。结果　致伤家兔伤后 4,8,2 4hcTnT含量均升高 ,与伤前比较相差非常显著 (P <0 .0 1) ,分别为伤前的 8 3,6 9,16 8倍。结论　cTnT含量检测对心肌损伤早期诊断具有一定的特异性和敏感性 ,是目前临床诊断心肌损伤较好的指标。     

心肌肌钙蛋白I与新生儿窒息心肌损伤的相关性分析

新生儿窒息心肌损伤是围产新生儿最常见的急危重症之一.有报告[1,2]认为,心肌肌钙蛋白(cTnI)对急性缺血性心肌损伤,尤其是微小心肌坏死诊断具有高度的敏感性和特异性,并能评价其预后.     

Cardiac troponin T release after prolonged strenuous exercise

Over the past 2 decades, there has been a large interest in cardiac troponin T (cTnT) elevations, which are often seen following endurance sport events. There have been many reports on this topic, although sometimes with different approaches. We reviewed the available literature on cTnT elevations after prolonged strenuous exercise and discovered profound differences in the percentage of subjects reported to have elevated cTnT concentrations. This could partly be attributed to differences in immunoassay characteristics, such as cross-reactivity with skeletal troponin T, and the use of different cut-off values used in the different studies. The elevations were transient, with levels decreasing to pre-event concentrations within 24-48 hours. This might be explained by the relatively short half-life of cTnT, or water imbalance during and after the event. The release mechanism of cTnT, as well as the long-term positive or negative effects, remains unclear. Future research should therefore be aimed at clarifying the release mechanism of cTnT. Furthermore, the benefits and the possible long-term negative aspects of prolonged exercise should be evaluated.     

H-FABP、NT-proBNP、cTnT和CK-MB在急性心肌梗死早期诊断中的价值比较

目的通过测定心型脂肪酸结合蛋白(H-FABP)、N-末端脑钠肽(NT-proBNP)、肌钙蛋白T(cTnT)和肌酸激酶同工酶(CK-MB)在急性心肌梗死(AMI)患者的早期诊断效率,对几种标志物在AMI早期诊断中的价值进行比较。方法测定84例AMI患者和72例不稳定型心绞痛(UA)患者血浆H-FABP、NT-proBNP、cTnT和CK-MB含量,各组之间进行比较,通过ROC曲线计算4种标志物在AMI早期诊断中的诊断效率、灵敏度、特异度和阴阳性预测值,比较几种标志物对AMI早期诊断价值。结果 AMI组的H-FABP、NT-proBNP、cTnT和CK-MB水平都明显高于UA组,两组比较,差异有统计学意义(P<0.05)。在AMI诊断上,H-FABP是4种标志物中诊断效率、灵敏度和阴性预测值最高的,cTnT是特异度和阳性预测值最高的,所有标志物诊断效率均具有统计学意义(P<0.01)。结论在AMI早期诊断上,4种标志物联合检测特别是H-FABP和cTnT联合检测能够明显提高AMI的诊断效率。     

Serum cardiac troponin response in adolescents playing basketball

Cardiac troponin release is generally found in adult athletes after continuous-type endurance exercises or sport competitions. The purpose of this study was to investigate whether the physical stress experienced by adolescents while playing basketball, an intense, intermittent-type sport, could induce transient elevations of the serum cardiac troponin T (cTnT) and I (cTnI). Serum cTnT and cTnI levels in 10 male adolescent players (age 15.0 +/- 0.7 yr) were assessed immediately before and at 2, 4 and 24 h after a game randomly selected from a preseason basketball-training program. At 4 h following the game, serum cTnT levels in four of the ten subjects were above the cutoff of 0.01 ng . ml (-1) for myocardial injury. Two of these four subjects had values higher than the acute myocardial infarction cutoff of 0.05 ng . ml (-1). In three of the four subjects, the serum cTnI was above the cutoff of 0.06 ng . ml (-1) for myocardial injury. Nevertheless, serum cardiac troponins at 24 h had returned to pre-exercise levels. These findings suggest that the physical stress encountered during intense, intermittent-type sports could cause release of cardiac troponins in some adolescents at low risk for cardiac disease.     

高原肺水肿治疗前后血清心肌肌钙蛋白T的变化

目的 探讨诊断和判别高原肺水肿（ＨＡＰＥ）状态的新指标。方法 在海拔３７００ｍ处对８例ＨＡＰＥ患者在治疗前及临床治愈后分别测定血清肌酸激酶同功酶（ＣＫ－ＭＢ）和ｃＴｎＴ两项指标。结果 ＨＡＰＥ患者血清ＣＫ－ＭＢ和ｃＴｎＴ临床治愈后较治疗前均降低,二者间的差别有非常显著性意义（Ｐ〈０．０１）。结论 ＨＡＰＥ时存在心肌损伤,血清ｃＴｎＴ是一项具有高灵敏度、高特异性的血清心肌损伤标志物,对ＨＡＰＥ的诊断、病情分析有一定的价值。     

Serum cardiac troponin T, troponin I, plasma BNP and left ventricular mass index in professional football players

Concentrations of cardiac troponins (cTn) in serum or plasma may be elevated in several disease states other than acute coronary syndromes. In heart failure and end stage renal disease, cardiac troponin T (cTnT) correlates positively with left ventricular mass index (LVMI). Exercise-induced elevation of cardiac troponins in well-trained athletes has been confirmed by several reports but the aetiology and clinical significance is unclear. In the present study, we measured baseline concentrations of cardiac markers and investigated whether or not serum cTnT is associated with left ventricular hypertrophy (LVH) in professional football players. METHODS: Twenty-three male professional football players with a mean age of 23 years (range 18-32) were studied. Echocardiography and blood sampling were carried out approx 24h after a training session. Serum cTnT, other cardiac markers and plasma brain natriuretic peptide (BNP) were compared with LVMI. RESULTS: cTnT was only detectable in one subject. The prevalence of elevated cardiac troponin I (cTnI), creatine kinase MB (CKMB) and creatine kinase was higher than for cTnT. cTnI concentrations were higher in football players than in controls. LVMI did not correlate with any of the cardiac markers. Plasma BNP concentrations were normal in all subjects. CONCLUSION: Serum cTnT concentrations were not elevated in healthy professional football players with LVH. This argues against the hypothesis that LVH per se may cause increased cTnT. The finding of higher cTnI in football players than in non-athletic controls should be confirmed and the aetiology elucidated.     

高原肺水肿患者血清肌钙蛋白T研究

目的 :探索高原肺水肿 (HAPE)患者血清肌钙蛋白 T(cTnT)的变化。方法 :放免法测定HAPE患者在一氧化氮(NO)治疗前后血清cTnT。结果 :cTnT治疗前显著高于治疗后 (P <0 0 1) ,SaO2 治疗后显著高于治疗前 (P <0 0 0 1) ,治愈率为 10 0 0 %。结论 :对较重的HAPE患者有心肌损害和心功能的下降 ;NO治疗HAPE是非常有效的 ,为HAPE治疗提供了新的方法     

Cardiac troponin T determination by a highly sensitive assay in postmortem serum and pericardial fluid

Purpose

The main objective of this study was to test, for the first time, a highly sensitive cardiac troponin T (cTnThs) assay in postmortem serum and pericardial fluid and to evaluate cardiac troponin T (cTnT) levels and their stability after death at different postmortem intervals, in an attempt to determine the viability of the cTnThs assay in the postmortem diagnosis of the cause of death.

Methods

cTnT levels were determined in serum and pericardial fluid samples taken from 58 cadavers at known postmortem intervals, whose causes of death were categorized into the following groups: (1) sudden cardiac deaths, (2) multiple trauma, (3) mechanical asphyxia, and (4) other natural deaths. cTnT was determined by inmunoassay, using the Troponin T highly sensitive STAT assay (Roche^®).

Results

Average cTnT levels measured by a highly sensitive assay in postmortem serum were markedly higher than clinical serum levels. Moreover, similar results, higher cTnT levels in postmortem pericardial fluid, were obtained when compared to levels found in pericardial fluid taken from two living patients during coronary artery bypass surgery. cTnT levels in both postmortem fluids remained stable for up to 34 h after death. No differences in cTnT levels in either postmortem fluid by sex and age were detected. Levels of cTnT found in pericardial fluid in the other natural deaths group were significantly lower than the cTnT levels found in that postmortem fluid from any of the other causes of death groups.

Conclusion

It is therefore reasonable to conclude that determination of cTnT by a highly sensitive assay in pericardial fluid can provide forensic pathologists with a complementary test to the diagnosis of cause of death.

     

Exercise-induced cardiac troponin T release: a meta-analysis

PURPOSE: Cardiac troponin T (cTnT) is a highly specific marker of myocardial damage and used clinically in the diagnosis of acute myocardial infarction (AMI). Release of cTnT has been demonstrated in several small studies after endurance exercise. The purpose of this study was to explore, using a meta-analytic approach, the incidence of postexercise cTnT release after endurance exercise. METHODS: Articles identified via Pubmed, SportDiscus, and Embase (1997-2006) searches using the key words cardiac troponin T, cTnT, cardiac biomarkers, and exercise; a search of bibliographies; and consultation with experts in the field were entered into a random-effects meta-analysis. We identified 26 relevant studies (1120 cases). Age, gender, and body mass of participants, as well as exercise mode and duration, were explored as possible moderator variables with meta-regressions. RESULTS: Postexercise cTnT levels exceeded the assay detection limit in 47% of participants (95% CI = 39-56%). The detection of postexercise cTnT after cycling events was approximately half that of running events (27 vs 52%, P = 0.042). The detection of postexercise cTnT decreased slightly as event duration increased (P = 0.022) and mean body mass decreased (P = 0.0033). Postexercise detection of cTnT was not affected by age (P= 0.309) and was only slightly higher for studies with more males in the sample (P = 0.028). CONCLUSIONS: Exercise-induced cTnT release is apparent in almost half of the endurance athletes who have been studied to date. Relatively heavy individuals competing in shorter endurance events, primarily running marathons, are slightly more likely to demonstrate elevated cTnT postexercise than other athletes. These data are useful for clinicians evaluating athletes with cTnT elevations after competitive endurance exercise events.     

Postgame elevation of cardiac markers among elite floorball players

Cardiac biomarker release after exercise is well documented in endurance sports, but neither the impact of intermittent high‐intensity exercise nor the reproducibility has yet been established. Floorball, a popular sport in Scandinavia, involves intermittent periods of high‐intensity exercise. This study aimed to determine the prevalence and reproducibility of elevated cardiac marker levels among elite floorball players after two games. Twenty‐three healthy male elite floorball players of median age 19 years (range 16–34 years) participated in two standard games. Blood was drawn at three time points: pregame, immediately after, and 2 h after the game. Creatine kinase MB (CK‐MB), myoglobin, and high‐sensitivity cardiac troponin T (hs‐cTnT) were measured. The results showed significantly elevated median postgame values in all markers. In both games, hs‐cTnT exceeded the cutoff for myocardial damage (≥ 14 ng/L) 2 h postgame in the same six players. The major findings were that postgame cardiac hs‐cTnT values among elite floorball players were significantly elevated and reproducible. The findings imply that extended investigations should incorporate evaluation of myocardial function and myocardial perfusion during exercise to seek the clinical significance and underlying mechanisms of elevated cardiac troponin after high‐intensity exercise.