心肌肌钙蛋白I在病毒性心肌炎诊断中的意义

目的探讨肌钙蛋白I(cTnI)在病毒性心肌炎(VMC)的诊断及病情观察方面的意义。方法对105例急性病毒性心肌炎患者进行入院后1、2、3周及3个月时的cTnI和心肌酶谱的动态分析;cTnI阳性率与心内膜心肌活检(EMB)病理检查诊断率的对照分析;cTn1与心电图(ECG)、及病程关系的分析。结果急性病毒性心肌炎患者在各检测期内血清cTnI的阳性率(46.7%)较心肌酶谱各项目肌酸激酶(CK)30.4%、肌酸激酶同工酶(CK-MB)35.2%、门冬氨酸氨基转移酶(AST)9.8%、乳酸脱氢酶(LDH)12.8%、a-羟丁酸脱氢酶(a-HBDH)12.3%]显著增高(P<0.005,P<0.05);cTnI阳性率(46.7%,49/105)与心内膜心肌活检病理诊断率(43.3%,13/30)差异无统计学意义(P>0.05);cTnI阳性组ECG正常率(10.2%,5/49)明显低于阴性组(25%;14/56)(P<0.05);cTnI阳性组3个月的总治愈率(65.3%,32/49)明显低于阴性组(91.1%,51/56)(P<0.005)。结论在病毒性心肌炎的诊断中cTnI可取代传统的心肌酶谱测定;cTnI具有与心内膜心肌活检同样重要的诊断价值;cTnI在病毒性心肌炎的病情观察中也具有重要意义。

The role of serum cardic troponin I in diagnosis and observation in patients with viral myocarditis

Objective] To investigate the value of cardic troponin I (cTnI) in diagnosis and observation in patients with viral myocarditis (VMC). Methods] Serum cTnI and cardiac enzymes were measured in 105 patients with acute VMC at different stages (admission, 1 week, 2 weeks, 3 weeks, 3 months); Comparition study was performed between the positive rate of cTnI with diagnosis rate of endomyocardial biopsy (EMB); The realations of cTnI with electrocardiograph (ECG) and course of disease were studied. Results] The positive rate of cTnI was significantly higher than cardiac enzyme levels at different stages (P <0.005, P <0.05); There was no significant difference between the positive rate of cTnI with diagnosis rate of EMB (P >0.05). The normal rate of ECG in positive group was significantly lower than that in negative group (P <0.05). The cure rate in positive group was significantly lower than that in negative group at 3 months (P <0.005). Conclusions] Measurement of serum levels of cTnI provides evidence of myocyte injury in patients with VMC more sensitively and specifically than convention determination of cardiac enzyme levels; cTnI and EMB are very important in diagnosis of VMC; cTnI also plays an important role in the observation in patients with VMC.