慢性心力衰竭患者血清中cTnI/T与不同心血管疾病的关系  

Relationship Between Serum cTnI/cTnT in Patients with Chronic Heart Failure and Different Cardiovascular Diseases

作　　者：陈瑞珍[1] 卜丽萍[1] 虞勇[1] 西雁[1] 韩蓓蓓[1] 高开屏[1] 郭棋[1] 蔡迺绳[1] 杨英珍[1] 

机构地区：[1]复旦大学附属中山医院-上海市心血管病研究所-卫生部病毒性心脏病重点实验室,上海200032

出　　处：《复旦学报（医学版）》2005年第6期653-656,共4页Fudan University Journal of Medical Sciences

基　　金：国家"十五"攻关项目(2001BA703B15)资助

摘　　要：目的探讨血清心肌肌钙蛋白(Tn)I/T(cTnI/cTnT)在慢性心力衰竭(心衰)中的意义以及其对心血管疾病发生发展的影响.方法110例临床诊断为慢性心衰患者,根据病因分为高血压、冠心病、扩张型心肌病3组,用化学发光法测定血清cTnI/T水平,用超声心动图测定左心室射血分数(LVEF)及左心室大小(LVDd、LVDs),同时进行肝、肾功能的常规检测.其中20例患者在临床治疗期间跟踪随访3～6个月,观察心功能的变化与cTnI/T的关系.结果血清cTnI在扩张型心肌病慢性心衰患者中显著高于其他组(P＜0.05),cTnI的阳性率在LVEF 31%～40%段明显增高,与LVEF≤30%、LVEF 41%～50%段比较,差异有显著性(P＜0.05);血清cTnT升高与血肌酐异常者呈显著相关,(r=0.345,P=0.005),而血清cTnI的升高与肌酐的高低无关.随访发现,经治疗后心功能改善的患者,血清cTnI/T显著下降;但是,若疗效不佳,心功能有恶化时,血清cTnI/T较治疗前有所升高,有显著统计学差异.结论扩张型心肌病患者可能存在慢性心肌损伤,其损伤程度在LVEF 30%～41%可能较重;慢性心衰患者肾功能损害对血清cTnT的影响较大,而cTnI不变,因此血清cTnI可作为评判慢性心肌损伤的特异指标.Purpose Relationship between serum cardiac troponin I/troponin T （cTnI/cTnT） and heart function in patients with chronic heart failure and the effect of cTnI/cTnT on development of the heart function were investigated. In addition, the correction of serum cTnI/cTnT level with abnormal liver or renal function in these patients were also investigated. Methods According to etiological factor divided 110 patients with chronic heart failure were divided into three groups： hypertension, coronary heart disease, and dilate cardiomyopathy （DCM）, respectively. The level of serum cTnI/cTnT were monitored quantitatively by using chemiluminescence method. The left ventricular dimension in systole and at end-diastole （LVDd, LVDs） and ejection fraction （EF） monitored for heart function were measured by high-frequency echocardiography. Meanwhile, the serum AST and creatinine were detected by usual methods for liver and renal function. Among these 110 patients, 20 patients were followed up 3 to 6 months for investigating the cor- rection of the change of cardiac function with the level of serum cTnI/cTnT. Results In patient with DCM, we found that the level of cTnI was statistically higher than that in other groups （P〈0.05）. The positive rate of serum cTnI was remarkably elevated in patients with LVEF 31%-40 %. Compared with the LVEF≤30% and LVEF 41%-50% sectors, it was statistically different （P〈0.05）. The serum cTnT elevation existed a significant positive correlation with abnormal increase of creatinine （r=0.345, P=0.005）.However, the level of cTnI showed no correlation with creatinine level. Our follow-up study demonstrated that serum cTnI/cTnT were descentent when cardiac function was improved, and while the cardiac function turned worse, the level of serum cTnI/cTnT were higher than before. Conclusions Probably, chronic myocardium damage was existed in patient with DCM, and the degree of impairment is more severity in 30%-41% sector of LVEF. The patients of chronic heart failure with rena

关 键 词：慢性心力衰竭 心肌肌钙蛋白I/T 心功能 肝肾功能 

分 类 号：R542.2[医药卫生—心血管疾病]