非特异性胸痛患者运动试验前后血清心肌肌钙蛋白I水平的变化

目的探讨以非特异性胸痛(ACP)患者运动负荷前、后血清心肌肌钙蛋白I(cTnI)值的变化,间接推断其是否存在心脏微血管病变的可能性.方法冠状动脉造影结果正常的ACP患者33例,健康正常人17例和冠心病心绞痛患者16例,均进行运动平板试验,并分别于运动前,运动后1小时、24小时进行血清cTnI浓度、CK值和LDH值的测定.结果ACP组中运动试验阳性者及冠心病心绞痛组患者运动后1小时及24小时血清cTnI浓度明显升高(P<0.01及 P<0.05),提示ACP组运动试验阳性者可能存在心脏微血管病变;ACP组中运动试验阴性者运动前、后血清cTnI浓度的变化无显著性差异.在冠心病心绞痛组患者中,运动试验后1小时血清cTnI浓度随患者病变程度的加重而逐渐增加,且变化有显著性差异(P<0.05).结论ACP患者运动负荷前后血清cTnI值的检测有助于间接推断患者是否存在心脏微血管病变,且其升高程度可以间接反映冠状动脉的病变程度.

Clinical significance of change of serum cardiac troponin I after exercise treadmill test in patients with atypical chest pain

Objective: To study the significance of change of serum cardiac troponin I (cTnI) after exercise treadmill test (ETT) for diagnosis of cardiac capillary vessel disease in patients with atypical chest pain (ACP). Methods: The study object included 33 ACP patients and negative coronary arterial angiography (negative CAG group), 17 healthy persons (normal control group) and 16 patients with positive coronary arterial angiography (positive CAG group). All the three groups were received ETT. The levels of serum cTnI, CK and LDH were measured before ETT and at 1 hour and 24 hours after ETT. Results: The levels of serum cTnI at 1 hour and 24 hours after ETT were significantly higher then before ETT in positive CAG group and positive ETT cases of negative CAG group (P<0. 01, <0. 05), suggest there was heart microangiopathy in positive ETT cases of ACP group. There was no significant difference of serum cTnI levels before and after ETT in ACP patients and negative ETT patients. Moreover the serum cTnI levels were closely associated witn the extent of coronary arterial disease (CAD) in positive CAG group. Conclusion: The change of levels of serum cTnI after ETT may contribute to cardiac capillary vessel disease in patients with atypical chest pain. It is useful as a indicator of the extent of CAD.