心肌钙蛋白I在监测非缺血性心肌损伤中的应用

目的 探讨心肌钙蛋白Ⅰ（cTnI)用于监测非缺血性心肌损伤的临床意义。方法 将67例临床未见急性心肌梗死（AMI）迹象的可疑心肌损伤患者分为2组：（1）急性心衰组37例，患者心功能分级为Ⅳ级；（2）烧伤组30例，体表烧伤总面积为4％－98％。定期采集2组患者血样品，并用微粒子化学发光法检测样本cTnI浓度。结果 89％的急性心衰组患者cTnI水平升高（P＜0．001），且与病情变化密切相关。当患者病情恶化时，cTnI水平升高；病情改善时，cTnI水平逐渐下降。90％的烧伤组患者cTnI水平在烧伤后第5－14天期间呈轻到中度升高。平均值比对照组水平明显升高者，见于体表烧伤总面积＞30％（P＜0．001）或创面有明显渗出的患者（P＜0．002）。当患者创面渗出明显或焦痂自然剥离时，cTnI水平升至峰值，手术切痂后，cTnI水平逐渐下降。2例cTnI水平持续性升高的患者发展为心动过速。结论 cTnI是一种敏感的非缺血性心肌损伤标志物，动态监测cTnI水平变化有助于鉴别上述两类患者的心肌受损程度。

Cardiac troponin I: a marker for detecting non-ischemic cardiac injury

OBJECTIVE: To investigate if cardiac troponin I (cTnI) could be used to monitor non-ischemic cardiac damage. METHODS: Two categories of patients without clinical evidence of acute myocardial infarction but suspected to have cardiac damage were included: acute heart failure (n = 37, heart function classified as class IV); and post burn injury (n = 30, TBSA 4% approximately 98%). Serum samples from these patients were analyzed for cTnI by chemiluminescent immunoassay. RESULTS: Elevated plasma cTnI was found in 89% of patients with acute heart failure (P < 0.001). Clinical conditions of the patients improved with declining of cTnI, while heart function deteriorated with the increasing of cTnI. Elevated plasma cTnI was also found between the 5(th) day to 14(th) day of post burn in 90% of burn patients. Mean cTnI level was significantly higher in patients with TBSA > 30% (P < 0.001) and in those patients with obvious burn wound exudation (P < 0.002). cTnI peaked when obvious burn wound exudation or eschar spontaneous separation. cTnI decreased after surgical excision. Two patients with persistent high cTnI developed tachycardia. CONCLUSION: cTnI is a sensitive marker for non-ischemic cardiac damage. Monitoring of cTnI is useful in differentiating the two categories of patients.