cTnT、cTnI在急性病毒性心肌炎诊断中的价值

目的 探讨心肌损伤指标肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)对急性病毒性心肌炎的临床诊断价值。方法116例首次诊断为急性病毒性心肌炎患者,在其发病的一至二周内,同时定量检测血清cTnT、cTnI和心肌酶谱系列肌酸磷酸激酶(CK)及其同功酶(CK-MB)、血清谷草转氨酶(sGOT)、乳酸脱氢酶(LDH)并作比较。结果 116例急性病毒性心肌炎患者中,共有53例cTnT异常升高,阳性率为45.7%;共有75例cTnI异常升高,阳性率为64.7%;而CK、CK-MB、sGOT、LDH检测阳性率分别为10.3%、7.8%、6.9%、12.9%。上述结果分别与cTnT及cTnI结果作卡方检验均有显著差异(P<0.01)。结论 病毒性心肌炎患者在急性期心肌损伤指标检测中,cTnT、cTnI比传统的CK、CK-MB、sGOT、LDH有更好的敏感度,是及时反映心肌损伤的良好的观察指标。     

心脏不停跳心内直视术中心肌肌钙蛋白T的测定及意义

目的 研究心脏不停跳心内直视术围手术期心肌肌钙蛋白T(cTn-T)的变化及意义。方法 检测26例心脏不停跳心内直视术患者术前,术中及术后血清cTn-T及肌酸磷酸激酶同功酶(CK-MB)。结果 cTn-T明显增高,于停机时达到最高峰后,出现下降趋势,术后2周仍高于术前水平。术后心功能不良患者,cTn-T持续上升。CK-MB于术后2小时达最高峰,术后1周即恢复至术前水平。结论 心脏不停跳心内直视术中,血清cTn-T可用于监测围手术期心肌细胞损伤和估价心肌保护效果。并有可能作为反映预后的指标,其敏感性、特异性及持续时间优于CK-MB。     

心力衰竭患者血清基质金属蛋白酶及骨桥蛋白、cTnI、cTnT与心室重构的关系

目的研究及观察心力衰竭患者血清基质金属蛋白酶(matrix metalloproteinase,MMP)及骨桥蛋白(osteopontin,OPN)、心肌肌钙蛋白(cardiac troponin,c Tn)I、c Tn T与心室重构的关系。方法选取2012年8月至2014年3月四川省阆中市人民医院收治的70例心力衰竭患者为观察组;另外选择同时期的70名健康人为对照组。将两组的血清MMP及OPN、c Tn I、c Tn T浓度分别进行检测及比较,然后比较观察组不同左心室舒张末期容积指数(left ventricular end-diastolic volume index,LVEDVI)及左心室体积指数(left ventricular mass index,LVMI)患者的上述指标,并以Logistic分析处理上述血清指标与心室重构的关系。结果观察组的血清MMP及OPN、c Tn I、c Tn T浓度均高于对照组,差异有统计学意义(P<0.05);且观察组中不同ΔLVEDVI和LVMI患者上述指标比较,差异有统计学意义(P<0.05)。Logistic分析结果显示,血清MMP及OPN、c Tn I、c Tn T浓度与心室重构均有密切的关系(P<0.05)。结论心力衰竭心室重构患者的血清MMP及OPN、c Tn I、c Tn T浓度呈现异常的状态,上述指标对于心室重构均有较高的反映价值。     

冠状动脉介入治疗对冠心病血浆心肌肌钙蛋白T的影响

目的：探讨冠状动脉介入治疗对冠心病血浆心肌肌钙蛋白T的影响。方法：随机抽取我院2013年2月～2015年2月收治的90例冠心病患者为研究对象,其中45例经冠状动脉介入治疗患者为观察组,45例冠状动脉造影呈阳性但未经冠状动脉介入治疗的患者为对照组,应用发光免疫法检测、比较两组患者手术前后心肌肌钙蛋白T(cTnT)的水平变化并找出潜在的影响因素。结果：两组组内术前、术后比较：观察组cTnT术后显著上升,对照组无明显变化;两组组间比较：观察组术后cTnT值显著高于对照组,差异比较具有统计学意义。结论：冠状动脉介入治疗对冠心病血浆心肌肌钙蛋白T存在一定影响,术后cTnT值上升,表明心肌出现一定程度损伤或血管内皮损伤,冠状动脉介入治疗能导致血浆心肌肌钙蛋白T的释放。     

High-sensitivity cardiac troponin T in geriatric inpatients

BackgroundHigh-sensitivity cardiac troponin T (hs-cTnT) is detectable in elderly patients without clinical diagnosed cardiovascular disease. Elevated hs-cTnT levels predict increased cardiovascular risks and poor prognosis. The aim of this study was to determine the distribution and associated factors of hs-cTnT in geriatric inpatients without acute coronary syndrome (ACS).MethodsHs-cTnT was measured with a highly sensitive assay in 679 geriatric inpatients without ACS. Patients were further divided into 3 groups according to the tertile of hs-cTnT levels and single and multiple variable analyses were performed to assess the association of hs-cTnT to cardiovascular risk factors, biochemical measurements and echocardiographic abnormalities.ResultsHs-cTnT was detectable (≥3 ng/L) in 98.4% of the subjects and 52.0% of the subjects had hs-cTnT levels ≥14 ng/L, which is at the 99th percentile Upper Reference Limit (URL). The levels of hs-cTnT were independently associated with N-terminal pro-brain natriuretic peptide (NT-proBNP), male gender, older age, estimated glomerular filtration rate (eGFR), left ventricular mass index (LVMI), diabetes mellitus (DM) and left ventricular ejection fraction (LVEF). There were no significant differences in hs-cTnT levels between geriatrics patients with stable coronary artery disease (SCAD) and those without SCAD.ConclusionHs-cTnT elevation caused by non-ischemic acute conditions was very common in geriatric hospitalized patients. Due to increases in baseline hs-cTnT in the elderly, detection of a rise and/or fall in hs-cTnT levels is essential for determining a diagnosis of ACS or AMI in geriatric patients. Further studies are needed to establish age-specific 99th percentile values of hs-cTnT for elderly individuals.     

血液透析患者血清肌钙蛋白T检测的临床研究

目的　观察维持性血液透析患者血清肌钙蛋白T(cTnT)与原发病、心血管事件及死亡事件的关系。　方法　对 5 7例维持性血液透析患者采用干化学方法测定血清cTnT水平 ,随访 1年。　结果　 5 7例患者中cTnT升高者 12例 ,死亡 7例 ,4例 (33 3% )死于急性左心衰 ,12例中有 8例原发病为糖尿病 ;cTnT正常者 4 5例 ,死亡 3例 ,1例 (2 2 % )死于心血管事件 ,两组比较差异有显著性 (P <0 0 0 1)。 2 4例患者测定了透析前后cTnT浓度 ,其中 6例透析前cTnT升高者 ,透析后有 5例cTnT仍进一步升高 ,1例下降但高于 0 1μg/L。　 结论　部分血液透析患者血清cTnT水平升高 ,原发病为糖尿病肾病的患者其发生率高 ,cTnT升高与急性心肌梗死无明确关系 ,但与血液透析患者死亡率及伴发心血管疾病有密切正相关关系 ,血液透析本身对cTnT无影响。     

血清肌钙蛋白T和心肌酶对心肌炎的诊断价值

目的：探讨肌钙蛋白T（cTnT)诊断VMC的价值。方法：对34例心肌活检的VMC患和25例健康对照组进行cTnT,CK,CK-MB检测。结果：（1）VMC患检出：①电镜阳性率100％（34／34）；②光镜阳性率58.8%(20/34)；③cTnT阳性率97.1%(33/34)；④CK－MB阳性率41.2%；⑤CK阳性率11.8%；（2）心肌炎心功能Ⅲ级患的cTnT，CK，CK－MB水平均高于Ⅱ级（P＜0.001)；（3）心肌炎病理变化与cTnT水平密切相关。结论：cTnT(≥0.12μg/L)是判断VMC患心肌损伤的最佳指标。     

Prognostic value of homocysteine and highly sensitive cardiac troponin T in children with acute heart failure

Objective

Heart failure (HF) is a progressive disorder in children. Many HF biomarkers have been identified to assess its severity and predict its course. The aim of this study was to evaluate the prognostic value of plasma levels of homocysteine (HCY) and highly sensitive cardiac troponin T (hs-cTnT) in children with HF.

Cardiac troponin T as a marker of myocardial damage caused by antineoplastic drugs in rabbits

Anthracycline derivatives are among the most effective antineoplastic drugs but their therapeutic use is limited by their adverse effects. The cardiac side-effects of antineoplastic drugs were investigated in rabbits in vivo from the viewpoint of release of cardiac troponin T (cTnT) measured by Elecsys Troponin T STAT immunoassay (Boehringer Mannheim, Germany). No increase in cTnT was found following administration of a single dose of daunorubicin (3 mg/kg i.v., n = 4). During development of daunorubicin-induced cardiomyopathy (daunorubicin 3 mg/kg i.v., once a week; maximum nine administrations, n = 7), the levels of cTnT were within the physiological range (i.e. cTnT < 0.1 μg/1) at the beginning of the experiment and before and after the 5th administration, but the pathological values of cTnT after the 8th administration in 43% animals (0.22 ± 0.08 μg/l) correlated with their premature death. In the control group, the levels of cTnT were always lower than 0.1 μg/l during the experiment. Following administration of a new antineoplastic drug – Oracin {6-[2-(2-hydroxyethyl) aminoethyl]-5,11-dioxo-5,6-dihydro-11H-indeno [1,2-c]-isoquinoline hydrochloride, 10 mg/kg i.v., once weekly, ten administrations, n = 7}, there was no increase in cTnT levels. These findings correlated with the PEP: LVET index, histological examination and no animal succumbing to premature death. It is possible to conclude that cTnT is a useful marker for the prediction of experimentally induced anthracycline cardiomyopathy and for the evaluation of cardiotoxic (and, possibly, cardioprotective) effects of new drugs in rabbits. Received: 1 October 1998 / Accepted: 23 November 1998     

Circulating concentrations of cardiac proteins in complicated and uncomplicated Plasmodium falciparum malaria

In an unmatched case-control study of 63 non-immune European patients with uncomplicated (n = 52) and complicated (n = 11) falciparum malaria, serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (H-FABP), myoglobin, troponin T and creatin kinase-muscle brain were compared. Elevated levels of NT-proBNP and H-FABP indicated myocardial impairment in complicated but not in uncomplicated falciparum malaria. The clinical impact of these findings remains to be evaluated. The pathophysiology of cardiac impairment in complicated falciparum malaria warrants further investigation.     

Direct current cardioversion does not cause cardiac damage: evidence from cardiac troponin T estimation

Aim—To determine whether elective direct current (dc) cardioversion of atrial fibrillation/flutter causes myocardial damage.
Methods and results—Cardiac troponin T and creatine kinase were estimated 20-28 hours after dc cardioversion in 51 patients who received dc shocks for elective cardioversion of chronic atrial fibrillation/flutter. Although creatine kinase was raised in 44 patients, cardiac troponin T was undetectable in all patients.
Conclusion—Cardiac damage does not occur as a result of cardioversion.

Keywords: cardioversion;  troponin T;  creatine kinase;  atrial fibrillation     

Elevated cardiac troponin T in predialysis patients is associated with inflammation and predicts mortality

OBJECTIVES: Cardiac troponin T (cTnT) is a highly sensitive and specific marker of myocardial damage. It has been shown that elevated serum concentrations of cTnT in haemodialysis (HD) patients are associated with poor prognostic outcome. The aim of the present study was to investigate the predictive value of cTnT in samples from predialysis patients and to investigate associations between cTnT and inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6). DESIGN: Cohort, follow-up study. SETTING: Huddinge University Hospital, Sweden. SUBJECTS: A total of 115 (62% males, 28% diabetic patients) end-stage renal disease (ESRD) patients (52 +/- 1 years), of which 29% had cardiovascular disease (CVD), were studied shortly before the onset of dialysis therapy. Sixty-four patients started peritoneal dialysis (PD) as renal replacement therapy, whilst 49 started HD during the follow-up. MAIN OUTCOME MEASURES: The cTnT was analysed with the third generation TnT assay on Elecsys 2010. The prognostic value was calculated for cTnT, IL-6, age, CVD, malnutrition, diabetes mellitus (DM) and gender. Survival analyses were made with Kaplan-Meier and Cox regression analyses, with all-cause mortality as the clinical end point (mean follow-up period 2.7 +/- 0.1 years). RESULTS: Significant correlations were found between cTnT and CKMB (rho = 0.52, P < 0.0001), IL-6 (rho = 0.23, P < 0.05), CRP (rho = 0.30, P < 0.05), and serum albumin (rho = -0.31, P < 0.001), respectively. Diabetic patients had higher median serum cTnT level (0.09 microg L-1; range <0.01-0.51 vs. 0.04 microg L-1; range <0.01-0.67 microg L-1; P < 0.005) compared with nondiabetic patients. Likewise, patients with CVD had a significantly higher median level (0.08 microg L-1; range <0.01-0.67 microg L-1 vs. 0.04 microg L-1; range <0.01-0.61 microg L-1; P < 0.01) of cTnT compared with patients without CVD. Patients with cTnT > or =0.10 microg L-1 had a higher cumulative mortality rate than patients with cTnT < 0.10 microg L-1 (chi2 = 7.04; P < 0.01). Whilst age, CVD, malnutrition, DM, IL-6, cTnT and male gender were associated with poor outcome in the univariate analysis, only DM (P < 0.05) and cTnT (P < 0.05) were independently associated with mortality in a multivariate analysis. CONCLUSIONS: The present study demonstrates that serum concentrations of cTnT > or =0.10 microg L-1 is a significant predictor of mortality in patients starting dialysis. Moreover, the positive correlations between cTnT and IL-6, and CRP, respectively, suggest an association between inflammation and cTnT levels. Finally, the results of the present study suggest that cTnT is an independent predictor of mortality in ESRD patients starting dialysis.     

A new mutation of the cardiac troponin T gene causing familial hypertrophic cardiomyopathy without left ventricular hypertrophy

AIM—To screen for a mutation of the cardiac troponin T gene in two families where there had been sudden deaths without an increase in left ventricular mass but with myocardial disarray suggesting hypertrophic cardiomyopathy.
METHODS—DNA from affected individuals from both families was used to screen the cardiac troponin T gene on an exon by exon basis. Mutation screening was achieved by polymerase chain reaction and direct sequencing. Where appropriate, a mutation was confirmed by restriction digest.
RESULTS—A novel missense mutation of exon 9 was found in the affected individuals of one of the families. This mutation at amino acid 94 resulted in the substitution of arginine for leucine and was not found in 100 normal control samples. A mutation of the cardiac troponin T gene was excluded in the second family.
CONCLUSIONS—A mutation of the gene for the sarcomeric protein cardiac troponin T can cause familial hypertrophic cardiomyopathy with marked myocyte disarray and frequent premature sudden death in the absence of myocardial hypertrophy at clinical or macroscopic level.


Keywords: hypertrophic cardiomyopathy; troponin T     

Cardiac troponin T is not increased in patients with hypothyroidism

Patients with hypothyroidism often have increased creatine kinase (CK) levels. It is possible that there is increased production of CK, but other mechanisms, such as an increased cell membrane permeability or decreased enzyme clearance were also proposed. Recently, troponins T and I have been extensively studied because of their cardiac specificity. Cardiac troponins are sensitive and specific markers of cardiac injury. The objective of the study was to measure cardiac troponin T (cTnT) levels in patients with hypothyroidism. Twenty-five patients with primary hypothyroidism were evaluated (thyroid-stimulating hormone (TSH) >30 mU/L and low FT₄). In all patients thyrotropin (TSH), free thyroxine (FT₄), CK, CK-MB and cTnT were measured.There were 3 men and 22 women with a mean age of 47.5 ± 12.4 years. TSH levels ranged from 31 to 75 mIU/L and mean FT₄ levels were 4.5 ± 1.9 pmol/L. CK was normal in 11 patients and increased in 14. CK levels ranged between 86 and 1221 U/L (normal levels <170 in women, <195 in men) with a mean of 322 U/L ± 279. CK-MB was increased in 4 patients (16%) and normal in 21. All 25 patients had normal cTnT levels, < 0.01 ng/mL (normal levels 0–0.1 μg/L). Increase in CK and its MB fraction are common in patients with hypothyroidism but cTnT levels are not, even in patients with increased CK-MB. Therefore, cTnT is a reliable marker of cardiac injury even in the hypothyroid patient.     

血清心肌肌钙蛋白T在射频消融治疗前后的变化

探讨射频消融合治疗对心肌细胞的损伤。方法测定了５３例行ＲＦＣＡ者的血清心肌肌钙蛋白Ｔ。结果术前ｃＴｎＴ无一阳性。术后阳性率６６．０％，且与放电次数，累积时间呈正相关。结论ＲＦＣＡＡ可对心肌细胞造成损伤。损伤程度与射频放电次数。累积放电时间相关。     

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.     

不稳定性心绞痛患者血清心肌钙蛋白T含量变化及临床意义

为探讨心脏特异性肌钙蛋白T（cTnT）在不稳定性心绞痛（UA）患者血清中检测的临床意义。应用酶联免疫法测定42例稳定性心绞痛（SA）患者和86例UA患者血清cTnT、肌酸磷酸激酶同功酶-MB（CK-MB）．并作对照分析。结果显示：SA患者血清cTnT无例升高（以cTnT＞0．2μg／L为界限值）；28例UA患者血消cTnT至少有1次升高．占32．6％，先均值为0．98±0．47μg／L，范围为0．20～1．86μg／L，这28例在入院后1周内有7例发生急性心肌梗塞（AMI），1例发生猝死；其余58例。cTnT不升高者中，在相同时间内，仅1例发生AMI，无猝死者。UA患者中cTnT阳性与阴性者的预后差别有统计意义（χ2=14．26，P＜0.001）。UA中CK－MB只有2例轻度升高，其中cTnT阳性与阴性各占1例。结果提示：①cTnT为较CK-MB更敏感、更特异的反应心肌损伤的指标；②UA中约有32．6％的患者血清cTnT异常升高，说明这部分患者已经发生心肌细胞损伤、心内膜下心肌梗塞或小灶性心肌梗塞，该类患者处于高危状态，极易发展成典型的AMI或猝死；③UA中cTnT不升高者，在很大程度上将有一个良好的预后。