应用Albunex评估无复流时肌酸磷酸激酶同工酶和肌钙蛋白I释放动力学变化的实验研究

目的 :通过检测肌酸磷酸激酶同工酶MB(CK MB)和肌钙蛋白I(cTnI) ,了解无复流时CK MB和cTnI的变化与心肌微血管损害之间的关系 ,分析微血管损伤对CK MB和cTnI释放的影响。方法 :19只犬通过制作急性心肌缺血 再灌注动物模型 ,采用弹丸式注射声学造影剂Albunex进行心肌声学造影研究 ;测定外周循环中CK MB和cTnI在基础状态、6 0min心肌缺血 (T0 )、再灌注 6 0min时的浓度(T60 ) ,计算再灌注 6 0min时其上升斜率 (T60 -T0 6 0 )和相对增加值 (T60 -T0 T0 )。结果 :CK MB和cT nI在心肌缺血 6 0min时外周血液浓度明显高于基础状态 (P <0 .0 1) ,复流组明显高于无复流组 (P <0 .0 1) ;6 0min再灌注时CK MB和cTnI的浓度、上升斜率和相对增加值复流组仍显著高于无复流组 (P<0 .0 1和P <0 .0 0 1)。结论 :心肌微血管床的损害影响缺血再灌注心肌酶和结构蛋白的释放。

Evaluation of release kinetics of serum creatine kinase isoenzyme MB and cardiac troponin I during no-reflow phenomenon determined by administration of Albunex

AIM: To validate the relationship between the release kinetics of serum creatine kinase isoenzyme MB (CK-MB) and cardiac tropnin I (cTnI) and myocardial microvascular impairment during the development of no-reflow phenomenon by measurement of serum CK-MB and cTnI in combination with administration of Albunex. METHODS: 19 dogs underwent 60 min myocardial ischemia,followed by reperfusion of 60 min (n=6),120 min (n=6) and 180 min (n=7),respectively. Myocardial contrast echocardiography(MCE) was performed by a bolus injection of Albunex. The measurement of peripheral blood concentrations of CK-MB and cTnI at baseline,60 min ischemia (T_0) and 60 min reperfusion (T_ 60 ) were initiated,and then the increase slope (T_ 60 -T_0/60) and relative increase value (T_ 60 -T_0/T_0) were calculated at 60 min reperfusion. RESULTS: The concentrations of serum CK-MB and cTnI were markedly higher at 60 min myocardial ischemia than those at baseline (P< 0.01 ). At 60 min reperfusion,a significant difference in the levels of CK-MB and cTnI was observed between reflow group and no-reflow group (P< 0.01 ). There was a marked difference in the levels of CK-MB and cTnI between reflow group and no-reflow group,too (P< 0.01 ). An extremely significant difference in the increase slope and relative increase value at 60 min reperfusion between two groups was found (P< 0.001 ). CONCLUSION: These findings show that damaged microvarculature may profoundly influence the release kinetics of serum CK-MB and cTnI.