PTCA术前后心肌肌钙蛋白Ⅰ的变化及与远期心脏事件的关系

目的：评价经皮冠状动脉腔内成形术（PTCA）对心肌的可能影响。方法：对173例PT－CA术的冠心病患者分别测定其术前、术后血清心肌肌钙蛋白I（cTnI)及肌酸激酶同功酶（CK－MB），随访各例远期心脏事件，结果42例术前cTnI正常，术后升高；84例术前、术后均正常；47例前、术后均升高。1 CK－MB术前术后均升高，10例CK－MB术后增高，血清cTnI升高与球囊扩张总时间、压力、次数、支架植入数、造影剂用量及术中胸痛发生有关（P＜0．05）。162例在平均21个月的随访期中，26例发生心脏事件，各组间远期心脏事件比较无显著差异（P＞0．05）。结论：用cTnI监测PTCA术患者心肌损伤较CK－MB更敏感和特异；PTCA造成的心肌损伤与操作有关，但并不影响PTCA的疗效。

Changes of serum cardiac troponin levels after percutaneous transluminal coronary angioplasty and its relation to late cardiac events

Objective　To evaluate the possible effect of percutaneous transluminal coronary angioplasty(PTCA) on myocardial injury. Methods　Serum cTnI and CK-MB levels were measured in 173 patients with coronary artery disease undergone PTCA before and 6, 12, 24, 48 and 72 hours after the procedure. Cardiac events during follow-up in these patients were recorded. Results　Serum cTnI level was increased after PTCA in 42 patients, remained normal in 84, and was over baseline level before and after the procedure in 47. Serum CK-MB level was above baseline before and after the procedure in one patient and increased in 10. Compared with normal cTnI group, elevated cTnI was related to total balloon inflation time, total pressure, number of dilation and stents deployed, contrast medium dose and occurrence of angina during balloon inflation (P<0.05). During a follow-up of 7～36 months in 162 patients, there were 34 late cardiac events in 26 patients, and cTnI did not represent the number of worse late outcome (P>0.05). Conclusion　cTnI was more sensitive and specific than CK-MB in identifying minor myocardial injury during PTCA. This injury was related to the intensity of PTCA, but not enough to make worse influence on overall outcome.