血清肌钙蛋白T对急性心肌梗塞溶栓疗效的判定价值  

Predictive Value of Troponin T for the Efficacy of Thrombolytic Therapy on Acute Myocardial Infarction

作　　者：项志敏[1] 胡大一[1] 崔亮[1] 陈牧雷[1] 鲍德兰 连桂清 王红[1] 王雷[1] 

机构地区：[1]首都医科大学北京红十字朝阳医院心脏中心

出　　处：《中国动脉硬化杂志》1996年第3期208-211,共4页Chinese Journal of Arteriosclerosis

摘　　要：为了探讨血清肌钙蛋白Ｔ浓度对急性心肌梗塞静脉溶栓治疗疗效的判定价值。选择接受静脉溶栓治疗的急性心肌梗塞患者９２例，以酶联免疫吸附测定法测定血清肌钙蛋白Ｔ浓度，比较其中６５例梗塞相关血管再通组与２７例未通组之间的血清肌钙蛋白Ｔ变化特点。结果发现：（１）大部分急性心肌梗塞患者于发病后第４～８ｈ血清肌钙蛋白Ｔ开始升高，且再通组比未通组有提前升高的趋势（但Ｐ＞０．０５）；（２）再通组比未通组，发病后第一峰值时间提前（１７．８±１２．５ｈ比２８．６±１６．０ｈ，Ｐ＜０．００１）；且第一峰值水平有升高趋势（３４．６±３９．１μｇ／Ｌ比２７．０±３１．６μｇ／Ｌ，Ｐ＞０．０５）；（３）对急性心肌梗塞的梗塞相关血管再通价值之敏感性、特异性及准确性，分别在肌钙蛋白Ｔ峰值时间≤１２ｈ为５５．４％、８５．２％及６４．１％；在≤１６ｈ为７６．９％、７７．８％及７７．２％，比ＣＫ－ＭＢ≤１４ｈ的６１；５％、７４．１％及６５．２％有更好的应用价值。提示肌钙蛋白Ｔ对于急性心肌梗塞的梗塞相关血管再通有一定判断价值，尤其以第一峰时间≤１６ｈ的敏感性较ＣＫ－ＭＢ为高。Aim To inquire into the predictive value of serum troponin T(TnT) levels for the therapeutic efficacy in acute myocardial infarction(AMI)treated by thrombolysis.Methods Ninety-two patients with AMI received venously thrombolytic therapy,of whom the infarct related coronary artery(IRA )were reperfused after thrombolysis in 65 cases.The serum TnT levels were detected by using of automatic enzyme-linked immunosorbent assay(ELISA),so as to analyse its characteristics and values for assessing the thrombolytic effects between reperfusion group and noreperfusion's.Results ①The TnT levels initiated rising 4th～8th hour post onset in most of AMI cases,especially earlier for reperfusion group than noreperfusion's(butP>0.05).②The time of arriving to first TnT peak from onset was earlier in reperfusion group than noreperfusion's(17. 78±12.49 h vs 28. 59±15.98 h,P<0.001):and the levels of first TnT peak was a little higher in the former than latter.③The sensitivity, specificity and accuracy of predicting IRA's reperfusion were55.4%, 85.2%and 64.1%respectively for the time reaching the first TnT peak≤12 h; while 76.9%,77.8%and 77.2%respectively for time reaching the first TnT peak≤16h.It was preferable to the CK-MB≤14 h , which was 61.5%,74.1%and 65.2%respectively.Conclusions TnT level s has certain predictive values for IRA reperfusion in AMI after thrombolysis.The sensitivity is higher for the time reaching the first TnT peak≤16h than for CK-MB≤14h.

关 键 词：急性 心肌梗塞 肌钙蛋白T 溶栓疗法 

分 类 号：R542.220.5[医药卫生—心血管疾病]