血清肌红蛋白动态变化对急性心肌梗死病人冠脉再通的诊断价值  

DYNAMIC CHANGES OF MYOGLOBIN IN CO RONARY REPERFUSION OF AMI

作　　者：谭丽娟[1] 范洪亮[1] 初开秋[2] 孟军[3] 周常勇[3] 

机构地区：[1]青岛大学医学院附属医院特需病房,青岛266003 [2]青岛大学医学院附属医院检验科,青岛266003 [3]青岛大学医学院附属医院急症科,青岛266003

出　　处：《齐鲁医学杂志》2001年第4期287-288,共2页Medical Journal of Qilu

摘　　要：①目的　探讨血清肌红蛋白是否可作为判断急性心肌梗死 (AMI)再灌注的一个早期指标。②方法测定 4 4例急性心肌梗死病人溶栓治疗前后血清肌红蛋白和CK MB水平 ,采用双抗体法检测血清肌红蛋白 ,酶联耦合法检测血清CK MB .③结果　再灌注组肌红蛋白上升速度快 ,酶峰出现在发病后 ( 5 .5 3± 1.19)h ,而未灌注组肌红蛋白上升速度缓慢 ,酶峰出现在发病后 ( 10 .0 0± 1.5 9)h .两组肌红蛋白酶峰出现时间比较有显著差异 (t =9.3 7,P <0 .0 0 1)。再灌注组CK MB活性峰值出现在发病后 ( 13 .0 0± 1.3 6)h ,未灌注组CK MB活性峰值出现在发病后 ( 2 2 .86± 1.87)h ,两组比较有显著差异 (t=17.67,P <0 .0 0 1)。再灌注组肌红蛋白酶峰前移的灵敏度为90 .3 % ,特异度为 84 .6% .再灌注组CK MB活性峰值前移的灵敏度为 90 .0 % ,特异度为 80 .2 % .再灌注组肌红蛋白酶峰与CK MB活性峰值出现时间比较也有显著差异 (t=2 2 .67,P <0 .0 0 1) ,但二者酶峰前移的灵敏度和特异度比较 ,差异均无显著性 ( χ2 =0 .0 0 2 ,0 .15 7,P >0 .0 5 )。Objective\ To study whether myoglobin to be an early parameter for determination of coronary reperfusion in AMI.\ Methods\ Serum Mb and CK MB were measured in 44 patients with AMI before and after thrombolytic therapy with double antibody method and ELISA met hod respectively. \ Results\ The peak of Mb was 884.7ng/mL, which appeared at 5.53 ± 1.19 hours after the onset of the symptom in the reperfusion group . The peak of Mb was 836.31ng/m, which appeared at 10.00 ± 1.59 hours after the onset in the unreperfusion group . There was significant difference in the time of the p eak of Mb between the two groups( t=9.37, P <0.001). The time of the peak of CK MB was 13.00 ±1.36 hours after the onset of the symptoms in the reperfusion group and 22.86±1.87 hours in the unreperfusion group. There was significant d ifference between the two groups( t=17.67,P <0.001). In the reperfusion group , the sensitivity of peak Mb shifting ahead was 90.3%, specificity 84.6%. In the reperfusion group , the sensitivity of peak CM MB shifting ahead was 90.0%, sp ecificity was 80.2%. There was also significant difference in the time of the pe ak between Mb and CK MB in reperfusion group( t=22.67,P <0.001). There was n o significant difference in the sensitivity and specificity of the peak shiftin g ahead ( χ 2=0.002, 0.157, P >0.05). \ Conclusion\ Myoglobin can be an early parameter for judging corona ry reperfusion in patients with AMI .

关 键 词：心肌梗死 肌红蛋白 肌酸激酶同工酶类 冠脉再通 再灌注损伤 

分 类 号：R542.22[医药卫生—心血管疾病]