急性脑卒中时心肌酶学变化的临床意义  

Clinical significance of changes in myocardial enzyme pedigree in patients with acute stroke

作　　者：樊双义[1] 王天昊[1] 刘景峰[1] 池春[1] 徐浩民[1] 

机构地区：[1]解放军总医院第二附属医院急救部,北京100091

出　　处：《中国卫生检验杂志》2008年第3期470-472,共3页Chinese Journal of Health Laboratory Technology

摘　　要：目的：探讨急性脑卒中时心肌酶学变化，及其与脑血管疾病预后的关系。方法：对420例患者分为脑卒中组（对照组286例）及脑卒中合并心肌酶升高组（134例），进行心肌酶、心肌酶同工酶、肌钙蛋白检测，并对所得资料进行统计分析；利用美国国立卫生研究院卒中量表评分（NIHSS）比较两组神经功能缺损情况。结果：脑卒中合并心肌酶升高组（32%）患者血清cTn-I、CK在病后4-48 h、3 d、7 d均增高，与对照组比较均有显著性差异（P〈0.01）；血清CK-MB在病后2-48 h、3 d均增高，与对照组比较均有显著性差异（P〈0.01）；发病1 d内患者平均NIHSS评分两组比较无差异（P〉0.05），发病3-14 d患者平均NIHSS评分两组比较有差异（P〈0.01），脑卒中合并心肌酶升高组神经损害程度重，病情改善程度均较对照组差。结论：脑血管疾病急性期心肌酶、肌钙蛋白异常者，检测值越高，说明病情严重，预后不良；在救治过程中应密切观察心脏情况，及时发现心脏损伤，并给予及时治疗，以降低卒中合并心脏损害患者的致残率、死亡率，改善预后。Objective：To investigate the changes in myocardial enzyme pedigree in acute stroke and explore their relation to prognosis of cerebrovascular diseases. Methods：A total of 420 patients with acute stroke were divided into the stroke group （group A, n = 286） and stroke plus myocardial enzyme elevation group （ group B, n = 134）. The serum levels of cTn - I, CK and CK - MB were determined in all the patients. NIHSS was used to compare the nervous functional damage between the 2 groups. Results： The serum levels of cTn and CK were significantly higher in group than in group A 4 - 48 h, 3 d and 7 d after onset of the acute stroke （P 〈0. 01 ）. The serum level of CK - MB was markedly higher in group B than in group A 2 -48 h and 3 d after the disease onset （P〈0.01）. The NIHSS in group B was not remarkably different from that in group A 1 d after the onset. However, there was significant difference in NIHSS between the 2 groups 3 - 14 d after the onset. Conclusion：Cardiac functional damage is common in patients with acute stroke. Therefore, monitoring of changes in myocardial enzyme pedigree is critical in these patients.

关 键 词：脑卒中 心肌酶 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]