急性心肌梗死直接冠状动脉成形术后与溶栓再灌注后心肌肌钙蛋白I的比较

目的通过观察急性心肌梗死（AMI）患者直接经皮腔内冠状动脉成形术（PTCA）后的心肌肌钙蛋白I（cTnI）的动态变化，以探讨其与AMI溶栓再灌注后cTnI变化的关系。方法12例AMI直接PTCA的患者，系列采集血样，以ELISA法测定cTnI，绘出其释放曲线。选择68例AMI接受溶栓的患者，参照中华心血管病杂志编委会制定的《急性心肌梗死溶栓疗效参考方案），判定42例再通，26例未通，绘出cTnI释放曲线，比较二者的峰值时间和上升速度，并将溶栓再通组与直接PTCA组相比较。结果①溶栓再通组与溶栓未通组cTnI的释放主要为单峰形式，溶栓再通组的达峰时间明显早于后者，峰值水平及上升速度也明显高于溶栓未通组（P〈0．05）；②直接PTCA组与溶栓再通组相比，二者达峰时间几乎一致，前者的峰值水平及上升速率略高于后者，但二者无显著性差异（P〈0．05）。结论AMI后cTnI的峰值前移可作为AMI后溶栓再灌注的判断标准之一。

Comparison of cTnⅠ in AMI Patients Between Receiving Primary PTCA and Venous Therombolysis

Objective To observe and compare the change of the cTnI value in AMI patients receiving primary PTCA and venous thrombolysis.Methods Blood samples were collected seriesly in 80 AMI patients(12 receiving primary PTCA,68 receiving venous thrombolysis).ELISA was used to measure cTnI.In 68 AMI patients receiving venous thrombolysis 42 patients' cardiac muscle was reperfused and 26 were not.The peak time and the increasing speed of cTnI were compared between the thrombolytic patients of reperfusion and non-reperfusion patients,and were compared between the thrombolytic patients of reperfusion and the patients receiving primary PTCA.Results(1)The peak time of cTnI appeared earlier in the thrombolytic patients of reperfusion than that in the non-reperfusion patients.The peak value and the increasing speed of cTnI was significantly higher in the thrombolytic patients of reperfusion than that in the non-reperfusion patients.(2)The peak time of cTnI in the patients receiving primary PTCA was the same as that in the thrombolytic patients of reperfusion.The peak value and the increasing speed of cTnI was a little higher in the patients receiving primary PTCA than that in the thrombolytic patients of reperfusion,but which was not significant.Conclusion Moving-up of the peak time of cTnI can be a good marker to evaluate reperfusion in AMI thrombolytic patients.