急性心肌梗死溶栓疗效判断中血清酶测定时间的合理选择

目的　适时合理选择急性心肌梗死 (AMI)溶栓疗效判断中血清酶学指标。方法　回顾性分析 145例AMI溶栓患者血清酶学及心肌肌钙蛋白T(TnT)资料 ,其中男 10 7例 ,女 38例 ,平均年龄 (6 1 9± 9 3)岁。以无创指标判断溶栓成功者 110例 ,未成功者 35例。 6 5例行冠脉造影 ,梗死相关血管 (IRA)开通者 44例 ,未开通者2 1例。 5 9例同时测定TnT。结果　 (1)TnT首次异常检出率 84 7% ,高于肌酸磷酸激酶 (CK)同功酶 (CK -MB)(4 9 2 % ) (P <0 0 5 )。 (2 )溶栓成功、IRA开通者与溶栓未成功、IRA未开通者间CK/CK -MB峰值无显著性差异 (P >0 0 5 )。结论　 (1)TnT用于AMI心肌损伤早期诊断优于CK -MB。 (2 )CK/CK -MB峰值前移与溶栓成功与否、IRA开通与否有关 ,而CK/CK -MB峰绝对值与此无直接关系。对早期溶栓的AMI患者不必过早取血测定CK/CK -MB ,而在发病后 16～ 2 0h间取血测定即可满足判断酶峰是否前移的需要 ,从而减轻病人痛苦和经济负担。

Reasonable time selection of serum enzymes determination in assessing the efficacy of thrombolytics in patients with acute myocardial infarction

Objective　To select reasonable time of determining serum enzymes inassessing the efficacy of thrombolytic therapy in patients with acute myocardialinfarction(AMI).Methods　One hundred and fourty-five patients with AMI treated withthrombolytics were included.Male 107,female 38,with mean age of(61.9±9.3)years old.Thetreatment was successful in 110 patients and unsuccessful in 35 patients,judged byclinical standards.Coronary angiogram was done in 65 patients,showing the infarct-relatedartery patent in 44 patients and closed in 21 patients.Cardiac troponin T(TnT) wasdetermined in 59 patients at the same time.Results　(1)The positive rate of TnT(84.7%)forthe first sample was higher than that of CK/CK-MB(49.2%)(P＜0.05).(2)There was nosignificant difference in the peak value of CK/CK-MB between the patients with and withoutsuccessful thrombolytics/patent IRA(P＞0.05).Conclusion　(1)TnT is sensitive in earlydiagnosis of myocardial damage than CK-MB.(2)It is the peak time of CK/CK-MB that relatesto the efficacy of thrombolytics,but not the absolute peak value of CK/CK-MB.It issuggested that,in clinical work,the determination of CK/CK-MB between 14 and 20 hoursafter AMI be enough to judge the peak time of CK/CK-MB before or after 14/16 hours.Itwould alleviate patients' pain and reduce the unnecessary cost.