冠心病围术期心肌肌钙蛋白T动态变化及意义  

The perioperative release and significance of cardiac troponin T in coronary artery bypass grafting

作　　者：刘志红[1] 姬尚义[1] 杨建安[1] 周莲英[2] 徐建玲[3] 

机构地区：[1]深圳市孙逸仙心血管医院外科,广东深圳518020 [2]深圳市孙逸仙心血管医院病案室,广东深圳518020 [3]深圳市孙逸仙心血管医院检验科,广东深圳518020

出　　处：《岭南心血管病杂志》2006年第3期159-161,共3页South China Journal of Cardiovascular Diseases

基　　金：深圳市医学科研基金资助项目(No:JH200507120909A)

摘　　要：目的比较心肌肌钙蛋白T(cardiac troponin T,cTnT)和心肌型肌酸激酶同工酶(MB isoenzyme of crcatine kinase,CK-MB)在冠状动脉旁路移植术(coronary artery bypass graft,CABG)围术期变化。方法在体外循环下行CABG术40例,年龄(61±18)岁,每例平均旁路移植2．8支,体外循环时间(118±57) min,主动脉阻断时间(58±35)min。围术期9个时间点取静脉血标本,测定cTnT与CK-MB。心肌缺血或心肌梗死的诊断用心电图、超声心动图及生化指标。结果主动脉阻断钳开放后cTnT与CK-MB均明显升高,开放后10 h达峰值,术后5 d CK-MB恢复至术前水平,而cTnT术后10 d才恢复至术前水平。手术期间心肌梗死(perioperative myocardial infarction,PMI)4例,cTnT。在整个围术期均显著高于无PMI者,在术后10 d仍明显高于正常范围,因PMI术后死亡2例(2／4)。结论cTnT与CK-MB在CABG术后前阶段改变化相似,但cTnT持续在正常值以上的时间长,诊断心肌损伤的敏感性与CK-MB类似,是预测CABG术预后的可靠指标。Objectives To investigate the perioperative release of cardiac troponin T（cTnT）and creatine kinase-MB isoenzyme （CK-MB） and their efficacy and difference in diagnosing myocardial injury in coronary artery bypass grafting（CABG）. Methods In 40 patients, activity of cTnT and CK-MB in serum were analyzed before and after operation at 9 different time intervals. The mean age was （61.3±18.5） years（41～76）. The average number of graft was 2.8（1～5） per patient, mean CPB time was（118±57） minutes and aortic cross-clamping time was（58±35） minutes. We evaluated the prognosis of patients with the ECG, echocardiographic and biochemical criteria. Results The concentration in blood of cTnT and CK-MB both elevated after aortic cross-clamping release and reached peak after 10 hours of cross-clamping release. Five clays later of operation, the CK-MB resumed to level of preoperation. But the cTnT needed 10 days for that. cTnT in 4 patients with perioperative myocardial infarction（PMI） was significantly higher than that of non-PMI during the perioperative period. Ten days after surgery, it still higher than the normal level. Two of these 4 patients died of PMI after operation. Conclusions The change of cTnT and CK-MB is the similar at the preceding stage after coronary artery bypass grafting. But the time which cTnT is higher than the normal level is longer than that of CK-MB. Because of its higher sensitivity and specificity than CK-MB. cTnT is the reliable biochemical marker to predict the prognosis of coronary artery bypass grafting.

关 键 词：心肌肌钙蛋白T 肌酸激酶同工酶 冠状动脉旁路移植术 心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]