肌钙蛋白T对急性非Q波心肌梗死早期诊断及近期预后的临床价值

目的　评价肌钙蛋白 T(c Tn T)在非 Q波心肌梗死 (NQMI)患者早期诊断及近期预后判断中的意义。方法　对 74例急性 NQMI患者和 118例急性 Q波心肌梗死 (QMI)患者的 c Tn T和肌酸激酶同工酶 (CKMB)进行动态分析 ;并于病程 15 d行心肌核素断层显像 ,计算梗死面积指数。两组患者均详细记录 2 8d内心功能不全、致命性心律失常、再梗死及心脏性猝死等心脏事件的临床资料。结果　 c Tn T上升时间较 CK MB提早 ,高峰时间与 CK MB平行 ,持续时间较 CK MB延长 ;两组患者 c Tn T和 CK MB峰值与梗死面积指数均呈正相关 (P均 <0 .0 1)。 NQMI组 c Tn T和 CK MB峰值均较 QMI组降低 ,且梗死面积缩小 (P均 <0 .0 5 ) ;随 c Tn T浓度升高 ,两组发生近期心脏事件的比例均显著升高 ,但 NQMI组较 QMI组低 (P<0 .0 5 )。结论　c Tn T可作为 NQMI患者早期诊断、早期估测梗死面积并对近期预后进行评价的简便而有效指标。

Study on the clinical value of serum cardiac troponin T in early diagnosing of acute non-Q-wave myocardial infarction and prognostic evaluation

Objective To investigate the value of serum cardiac troponin T (cTnT) in diagnosing earlier acute non-Q-wave myocardial infarction (NQMI) and judging the prognosis. Methods Seventy-four NQMI patients and 118 Q-wave myocardial infarction(QMI) patients were studied. Serum cTnT and MB isoenzyme of creatine kinase(CKMB) levels were monitored on fixed time. On the 15 th day of hospitalization, 99mTc-MIBI myocardial single photon emission computed tomography (SPECT) was performed to assess the infarct size index. Clinical informations of the two groups such as cardiac dysfunction, re-infarction, fatal cadiac arrhythmia, sudden death were collected. Results The time for serum cTnT beginning to rise was earlier than CK-MB. Its peak time value was paralled to that of CK-MB, and cTnT elevation lasted longer than CK-MB. Serum cTnT and CK-MB peak value showed positive correlation with the infarct size index(both P<0.01). The peak values of cTnT and CK-MB in NQMI group were lower than those in QMI group, and the infarct size was smaller than QMI group (all P<0.05). The frequency of cardiac events were significantly raised in both group when there was a high level of serum cTnT. But the proportion in NQMI group was less than those in QMI group(P<0.05). The cardiac events in NQMI group were less than that in QMI group(P<0.05). Conclusion Serum cTnT is an effective marker for diagnosing earlier NQMI, detecting myocardial damage, estimating infarct size and prognosis in the nearly future.