心肌肌钙蛋白T检测及其在病毒性心肌炎诊断中的价值

目的 探讨肌钙蛋白T（cTnT）在病毒性心肌炎（VMC）的诊断及病情观察方面的价值。方法 对102例急性病毒性心肌炎患者进行人院后1、2、3周及3个月cTnT和心肌酶谱的动态研究；cTnT阳性率与心内膜心肌活检（EMB）病理检查诊断率的对照研究；cTnT与心电图（ECG）、及病程关系的研究。结果 急性病毒性心肌炎患者在各检测期内血清cTnT的阳性率（45．1％，）较心肌酶谱各项目[肌酸激酶（CK）29．4％、肌酸激酶同工酶（CK-MB）34．3％、门冬氨酸氨基转移酶（AST）10．9％、乳酸脱氢酶（LDH）13．7％、α-羟丁酸脱氢酶（α-HBDH）12．8％]显著增高（P〈0．005，P〈0．05）；cTnT阳性率（45．1％，46／102）与心内膜心肌活检病理诊断率（40．6％，13／32）差异无统计学意义（P〉0．05）；cTnT阳性组ECG正常率（8．7％，4／46）明显低于阴性组（25％，14／56）（P〈0．05）；cTnT阳性组3个月的总治愈率（65．2％，30／46）明显低于阴性组（89．3％，50／56）（P〈0．005）。结论 在病毒性心肌炎的诊断中cTnT可取代传统的心肌酶谱测定；cTnT具有与心内膜心肌活检同样重要的诊断价值；cTnT在病毒性心肌炎病情观察中也具有重要意义。

To explore the role of serum cardic troponin T in the diagnosis and observation in patients with viral myocarditis

Objective To investigate the value of cardic troponin T (cTnT)in the diagnosis and observation in patients with viral myocarditis.(VMC).Methods Serum cTnT and cardiac enzymes were measured in 102 patients with acute VMC at different stages(admission,1 week,2 weeks,3 weeks,3 months); Comparition study were performed between the positive rate of cTnT with diagnosis rate of endomyocardial biopsy(EMB); The realations of cTnT with electrocardiograph(ECG)and course of disease were studied.Results The positive rate of cTnT was significantly higher than cardiac enzyme levels at different stages (P<0.005,P<0.05); There is no significant difference between the positive rate of cTnT with diagnosis rate of EMB(P>0.05). The normal rate of ECG in positive group was significantly lower than negative group (P<0.05). The cure rate in positive group was significantly lower than in negative group at 3 months(P<0.005).Conclusions Measurement of serum levels of cTnT provides evidence of myocyte injury in patients with VMC more sensitively and specifically than does convention determination of cardiac enzyme levels;cTnT and EMB are very important in diagnosis of VMC;Cadic damage in positive group were more severe than in negative group.cTnT also plays an important role in the observation in patients with VMC.