联合检测cTnI、MYO和CK-MB mass对病毒性心肌炎诊断的评价

目的 探讨联合检测心肌肌钙蛋白(cTnI)、肌红蛋白(MYO)和肌酸激酶同工酶MB质量(CK-MB mass)对病毒性心肌炎(VMC)的诊断价值.方法 在61例VMC和74例非病毒性心肌炎(NVMC)患儿及46例健康对照组中,用微粒子化学发光免疫分析法检测血清cTnI、MYO、CK-MB mass,并用连续监测法测定血清LDH、AST、CK和α-HBDH的活性.cTnI、MYO和CK-MB mass不同组合的诊断效率运用矩阵决策法评价.结果 入院当日VMC组cTnI(0.46±0.21μg/L)、MYO(98.7±38.2μg/L)、CK-MB(6.1±4.2μg/L)均明显高于NVMC组(分别为0.06±0.04、39.2±26.8、2.2±1.7μg/L)和对照组(分别为0.07±0.04、36.5±24.7、2.1±1.5μg/L,P＜0.01).cTnI、MYO、CK-MB mass联合检测对VMC诊断的灵敏度、特异性、阳性预报值、阴性预报值和诊断准确度分别为90.16%、85.14%、83.33%、91.30%和87.41%,其特异性、阳性预报值和诊断准确度明显比四种心肌酶联合检测法高(P＜0.05),而灵敏度和阴性预报值与后者相比差异无显著性(P＞0.05).MYO对VMC初诊的灵敏度较高,特异性欠佳,阳性持续时间短;cTnI与CK-MB对VMC诊断的特异性好,持续时间长,初诊时的灵敏度不够理想.VMC患者康复时以MYO恢复最快,CK-MB次之,cTnI最慢.结论 联合动态检测cTnI、MYO和CK-MB mass可使VMC的诊断效率进一步提高.     

实验性肺炎大鼠肌钙蛋白T的变化及其与心脏收缩功能的关系

目的探讨实验性肺炎大鼠血清肌钙蛋白T(cTnT)的变化及其与心脏收缩功能的关系,以明确肺炎是否可引起心肌受损,以及发生心肌受损的机理。方法建立金黄色葡萄球菌肺炎大鼠模型后第5天行经胸超声心动图检查。测量指标:左室舒张末内径(LVDD)、左室收缩末内径(LVSD)、主动脉血流峰值流速(PFVA)、主动脉血流速度积分(Viao)、肺动脉血流峰值流速(PFVP)、肺动脉血流速度积分(Vipa),并计算左室射血分数(LVEF)、左室短轴缩短率(LVFS)。采用酶联免疫吸附法检测大鼠血清cTnT的水平,并分析cTnT与心脏收缩功能的关系。结果肺炎组大鼠与对照组比较,PFVA、PFVP、Viao、Vipa、LVEF、LVFS显著减少(P均<0.01)。肺炎组大鼠血清cTnT水平显著高于对照组,且与LVEF、LVFS呈负相关(P均<0.05)。结论严重金黄色葡萄球菌肺炎可引起心力衰竭,其发生机理与心肌损害和肺动脉高压有关。血清cTnT可作为诊断心肌受损的生化指标。     

冠心病变患者血浆肌钙蛋白I和尿酸水平的临床研究

目的探讨冠状动脉不同病变程度的血浆肌钙蛋白I（TnI）、尿酸（UA）的水平变化。方法选择经冠状动脉造影确诊的冠心病患者80例纳入冠心病组,同期纳入非冠心病患者26例作为对照组,其中冠心病组又按照病变支数分为单支病变组（n=29）,双支病变组（n=29）,多支病变组（n=22）。采用累计积分法计算所有患者冠状动脉狭窄程度,分别测定各组平均血TnI、UA水平,并对TnI、UA与冠状动脉狭窄程度的相关性进行统计学分析。结果对照组患者血TnI、UA值分别为（0.014±0.01）μg/L及（295.682±45.43）μmol/L;冠脉单支病变组、双支病变组及多支病变组的TnI值分别为（5.453±12.29）μg/L、（16.022±28.56）μg/L和（20.552±30.25）μg/L,血UA值分别为（357.821±74.91）μmol/L、（389.907±82.19）μmol/L和（401.122±83.81）μmol/L。冠心病组患者TnI和UA水平均值明显高于对照组,差异有统计学意义（P均＜0.05）。同时,冠心病多支病变组TnI水平与单支病变组比较更高,差异具有统计学意义（P＜0.05）;冠心病其余各两组间TnI、UA水平比较无统计学差异（P＞0.05）。TnI、UA水平均与冠状动脉狭窄程度呈显著性正相关（r值分别为0.673及0.440,P＜0.01）。结论冠心病患者的TnI和UA水平显著增高,而且冠脉病变程度越重,升高越明显。     

cTnI CRP和BNP联合测定对缺血型心力衰竭患者诊断和预后的判断价值

目的探讨心肌肌钙蛋白I（cTnI）、C-反应蛋白（CRP）和B型钠尿肽（BNP）联合检测对缺血型心力衰竭（心衰）诊断和预后的判断价值。方法收集并测定98例缺血型心衰的不同心功能分级患者及95例冠心病无心衰患者血清cTnI、CRP和血浆BNP等指标,并进行比较,随访观察患者近期心脏事件再发生情况。结果心衰患者不同心功能分级组血清cTnI、CRP和血浆BNP水平与无心衰组之间差异均有统计学意义,且心功能越差,其浓度越高（ P均＜0.05）。发生心脏事件组患者出院时血清cTnI、CRP和血浆BNP浓度明显高于未发生心脏事件组（ P均＜0.05）。结论血清cTnI、CRP和血浆BNP在心衰患者中明显升高,三者联合检测对心衰患者临床诊断和预后判断有重要意义。     

Weak diagnostic performance of troponin,creatine kinase and creatine kinase-MB to diagnose or exclude myocardial infarction after successful resuscitation

Background

The aim of this study is to evaluate the diagnostic accuracy of the cardiac injury markers troponin (TNT), creatine kinase (CK) and creatine kinase-MB (CK-MB) to diagnose or exclude acute myocardial infarction after cardiac arrest.

Methods

226 patients who underwent diagnostic coronary angiography after sudden cardiac arrest were analyzed retrospectively. Levels of TNT, CK and CK-MB on admission and 6 h, 24 h and 36 h later were retrieved from the files and compared with the results of coronary angiography.

Results

Acute myocardial infarction (AMI) as well as non-AMI patients showed increasing levels of TNT and CK after resuscitation, although the AMI group showed significantly higher TNT and CK levels. Receiver operator curves were calculated to determine the diagnostic precision of TNT, CK and CK-MB to differentiate AMI and non-AMI patients. All analyzed markers yielded mediocre diagnostic precision with an area under the ROC curve of 0.7020, 0.6802 and 0.6508 for 6 h TNT, CK and CK-MB, respectively. Applying a modified cut-off of 1 μg/l the 6 h TNT measurement had a sensitivity of 70.9% and specificity of 61.2% to diagnose AMI after cardiac arrest. Using CK 800 U/l as cut-off level resulted in a sensitivity of 62.5% and specificity of 73.7%, CK-MB levels higher than 100 U/l yielded a sensitivity of 58.8% and specificity of 72.7%.

Conclusion

Cardiac injury markers cannot be used to reliably diagnose or rule out AMI after resuscitation. Consequently we propose that indication for coronary angiography should be extended to all patients without a certain alternative diagnosis explaining the occurrence of cardiac arrest.     

Diagnostic and Therapeutic Implications of Type 2 Myocardial Infarction: Review and Commentary

The Task Force for the Universal Definition of Myocardial Infarction recently published updated guidelines for the clinical and research diagnosis of myocardial infarction under a variety of circumstances and in a variety of categories. A type 1 myocardial infarction (MI) is usually the result of atherosclerotic coronary artery disease with thrombotic coronary arterial obstruction secondary to atherosclerotic plaque rupture, ulceration, fissuring, or dissection, causing coronary arterial obstruction with resultant myocardial ischemia and necrosis. Patients with a type 2 MI do not have atherosclerotic plaque rupture. In this latter group of patients, myocardial necrosis occurs because of an increase in myocardial oxygen demand or a decrease in myocardial blood flow. Type 2 MI has been the subject of considerable clinical discussion and confusion. This review by knowledgeable members of the Task Force seeks to help clinicians resolve the confusion surrounding type 2 MI.     

快速固相免疫层析法测定心肌肌钙蛋白I及在AMI诊断中的应用

为探讨采用快速固相免疫层析法测定心肌肌钙蛋白Ⅰ(cTnI) 和选择性免疫抑制紫外法测定肌酸激酶同工酶(CK-MB)及在急性心肌梗死(AMI) 诊断中的价值,本文分别对52例AMI患者于胸痛发生后4、8、12、24、48h及第5、7d和26名正常对照者的血清进行了cTnI及CK-MB 的测定.结果表明,AMI组血清cTnI、CK-MB 的测定值均明显高于正常对照组,具有显著性差异(P<0.01 );AMI患者cTnI在4h及第5、7d时的阳性率均明显高于CK-MB,具有显著性差异(P<0.01 ).以上数据表明,cTnI在诊断急性心梗中具有较高的灵敏度及高度特异性,尤其是采用快速固相免疫层析法检测cTnI,可为快速诊断AMI提供依据,具有临床应用价值.     

心肌肌钙蛋白T和超敏C反应蛋白在不稳定型心绞痛危险分层中的作用

目的研究不稳定型心绞痛(UAP)患者血清心肌肌钙蛋白T(cTnT)和超敏C反应蛋白(hs-CRP)水平变化与冠状动脉造影结果的关系,以评价cTnT和hs-CRP在UAP危险分层中的作用。方法序贯征集来住院的确诊为BraunwaldⅢB级UAP患者120例。在患者入院时(0h)及第一个24h内(3、6、12、18h)分别采集血样,测定cTnT、hs-CRP和肌酸激酶同工酶-MB(CK-MB)血浓度。根据cTnT水平不同,将患者分为cTnT阴性组(80例)和cTnT阳性组(40例)。所有患者出院前都进行冠状动脉造影。结果cTnT阴性组与cTnT阳性组比较,hs-CRP水平较低(2.3mg/L与12.6mg/L,P=0.001),3支血管患病率较低(26%与43%,P=0.001),左冠状动脉主干患病率较低(5%与15%,P=0.04),冠脉栓塞患病率较低(4%与20%,P=0.006),重度狭窄的血管较少(65%与95%,P=0.001),一年内心血管事件发病率较低(2.5%与25%,P<0.001)。结论cTnT和hs-CRP可对UAP进行危险分层,对UAP的诊断、疗效监测及预后判断有重要作用。