心肌钙蛋白I在监测非缺血性心肌损伤中的应用  

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

作　　者：曾利剑[1] 陈怡霓[1] 伍敏仪[1] 吴燕昭 林之瑜 罗卓然 韦建瑞[3] 

机构地区：[1]暨南大学医学院第四附属医院广州市红十字会医院中心实验室,广州510220 [2]暨南大学医学院第四附属医院广州市红十字会医院烧伤科,广州510220 [3]暨南大学医学院第四附属医院广州市红十字会医院心内科,广州510220

出　　处：《中华医学杂志》2001年第7期393-395,共3页National Medical Journal of China

摘　　要：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 6 7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 .0 0 1) ,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 .0 0 1)或创面有明显渗出的患者 (P <0 .0 0 2 )。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。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%～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.

关 键 词：肌钙蛋白Ⅰ 充血性心力衰竭 烧伤 监测 

分 类 号：R542.2[医药卫生—心血管疾病]