急性心肌梗死患者血清磷酸激酶同功酶、肌钙蛋白Ⅰ及肌红蛋白浓度变化的比较研究
作者：裴德安 徐默玲 郑义通 胡世文
单位：裴德安(无锡市第二人民医院心内科,江苏 无锡 214002)；徐默玲(无锡市第二人民医院心内科,江苏 无锡 214002)；郑义通(无锡市第二人民医院心内科,江苏 无锡 214002)；胡世文(无锡市第二人民医院心内科,江苏 无锡 214002)
关键词：肌酸激酶同功酶类；肌钙蛋白I；肌红蛋白；心肌梗死,急性
心脏杂志000413摘要:目的:比较心脏标记物肌钙蛋白I(CTnI),肌红蛋白(Myo)在急性心肌梗死(AMI)的动态变化,以探讨其诊断价值。方法:用固相双位点化学发光酶联免疫测定法测定了13例AMI患者(5例溶栓再通、8例未溶栓)CTnI,Myo并与CK-KB进行比较。结果:①溶栓与未溶栓组CTnI在AMI胸痛后升高时间较CK-MB早(均P<0.01),但以Myo升高时间最早;溶栓成功组CK-MB,CTnI和Myo升高时间均较未溶栓组提前(均P<0.05);②溶栓与未溶栓组Myo达高峰时间较CTnI和CK-MB均早(均P<0.01),但CTnI与CK-MB达高峰时间相比无显著性差异(P>0.05);溶栓再通组CK-MB,CTnI及Myo达高峰时间均较未溶栓组提前(均P<0.05)；③CK-MB,CTnI和Myo 3种生化标记物以Myo最早恢复正常,而以CTnI在血清中持续时间最长。结论:Myo和CTnI在AMI早期诊断中有应用价值,CK-MB,CTnI及Myo 3者结合可以提高对AMI诊断的准确性。
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中图分类号:R542.22 文献标识码:A 文章编号:1005-3271(2000)04-0287-03
A comparative study on isoenzyme of serum creatin phosphokinase,cardiac troponin I and myoglobin concentration in patients with acute myocardial infarction
PEI De-an XU Mo-ling ZHENG Yi-tong HU Shi-wen
(Department of Cardiology,Second People′s Hospital of Wuxi,Wuxi Jiangsu 214002,China)
Abstract:AIM:To evaluate the diagnostic value of cardiac troponin I (CTnI) and myoglobin (Myo) in patients with acute myocardial infarction (AMI). METHODS:CTnI and CK-MB were detected with solid-phase two-site chemiluminescent enzyme immunometric assay and were compared with CK-MB in 13 patients with AMI (5 patients with thrombolysis and having successful reperfusion,8 patienrts without thrombolysis). RESULTS:① The detection of CTnI was earlier after the onest of chest pain than that of CK-MB (P<0.01), but the detection of Myo was earlier after the onset of pain than those of CK-MB activity and CTnI activity (P<0.01). The detections of CK-MB, CTnI and Myo were earlier in patients with thrombolytic treatment than those of CK-MB, CTnI and Myo respectively in patients without thrombolytic treatment. ②The time of the peak value of Myo occurs earlier than those of CTnI and CK-MB (P<0.01) in patients both with thrombolysis and without thrombolysis; but the time of peak value of CTnI and CK-MB had no significant deviation (P>0.05); The time of peak value of CK-MB, CTnI and Myo were earlier in patients with thrombolysis than that of CK-MB, CTnI and Myo respectively in patients without thrombolysis (P<0.05). ③The disappearance of Myo from the plasma after the onset of pain was earlier than those of CTnI and CK-MB in patients both with thrombolysis and without thrombolysis, and the CTnI ctivity disappearance from the plasma was latest in the three biochemical markers. CONCLUSION:The detection of Myo and CTnI is helpful in early diagnosis of AMI. We also conclude that the detection of the combination of CK-MB,CTnI and Myo can improve the accuracy of diagnosis in patients with AMI.
, 百拇医药
Key words:creatine kinase isoenzymes; troponin I;myoglobin;myocardial infarction,acute
磷酸肌酸激酶同功酶(CK-MB)是诊断急性心肌梗死(AMI)的重要指标,新的血清生化指标包括肌钙蛋白I(cardiac troponin I,CTnI)和肌红蛋白(myoglobin,Myo),据报道其敏感性和特异性均超过CK-MB。作者观察了血清CK-MB,CTnI及Myo在AMI患者中的动态变化,并进行对比研究,以探讨它们在AMI中的诊断价值。
1 对象和方法
1.1 对象 收集1999-01～1999-06 AMI患者13例,年龄48～82岁,平均63±11岁,其中5例行尿激酶溶栓治疗后再通,溶栓时间为胸痛后2.7±1.0 h,溶栓治疗用药方法与结果判断同文献[1],另8例未行溶栓治疗。AMI采血时间,在24 h内每3～4 h采血1次,以后于48,72,96 h各采血1次,再后为每1～2 d采血1次。
, 百拇医药
1.2 方法 ①用固相双位点化学发光酶联免疫测定法,抗体为抗心肌CTnI和Myo特异反应的单克隆抗体,化学发光底物为phosphate ester of adamantyl dioxetane,用 IMMULITE全自动分析仪(美国DPC公司)进行定量测定,质控血清CTnI批内CV 3.5%,批间CV 6.1%,Myo批内CV 2.6%,批间CV 7.2%。②CK-MB按德国临床化学学会(DKGC)推荐方法测定,试剂盒由上海申能生物技术公司提供。
1.3 统计学处理 所有数据以
±s表示,组间比较用t检验。
2 结果
2.1 升高时间比较 ①CTnI在AMI胸痛后开始升高时间比CK-MB早(P<0.01),但Myo升高时间比前二者均早(均P<0.01)。②溶栓再通组CK-KB,CTnI及Myo升高时间均较未溶栓组早(均P<0.05);且溶栓再通组CTnI升高时间亦较CK-MB早(P<0.05),但Myo升高时间更早(均P<0.05,表1)。
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表1 急性心肌梗死患者血清CK-MB,CTnI和Myo的变化比较(±s，h)
升高时间
高峰时间
恢复正常时间
组别
n
CK-MB
CTnI
Myo
CK-MB
CTnI
, 百拇医药
Myo
CK-MB
CTnI
Myo
全部
13
11.2±2.9b
7.1±1.7b
4.3±1.5b
20.0±8.9
16.1±3.0
10.5±4.4b
, 百拇医药
54±15b
264±50
36±13b
未溶栓
8
12.6±2.5b
8.0±1.2
5.1±1.1b
24.1±9.2
17.6±2.8
12.9±3.8b
, 百拇医药
58±16b
287±45
37±15b
溶栓再通
5
9.0±2.0a,c
5.7±1.4c
3.1±1.0a,c
13.4±1.5c
13.7±1.1c
, http://www.100md.com
6.7±2.0b,c
49±11b
227±33
34±8b
CK-MB:磷酸肌酸激酶同功酶;CTnI:肌钙蛋白I;Myo:肌红蛋白;同CTnI比较,aP<0.05,bP<0.01;与未溶栓比较,cP<0.05。2.2 高峰时间比较 ①Myo达高峰时间较CK-MB和CTnI均早(均P<0.01),但CTnI和CK-MB达高峰时间相差不显著(P>0.05)。②溶栓再通组CK-MB,CTnI及Myo达高峰时间均较未溶栓组提前(均P<0.05)。而溶栓再通后CK-MB达高峰时间与CTnI无显著差异(P>0.05),但Myo较CK-MB和CTnI均早(P<0.01,表1)。
, 百拇医药
2.3 恢复正常时间的比较 ①AMI患者CK-MB,CTnI及Myo 3种生化标记物以Myo首先恢复正常,而以CTnI最迟(均P<0.01);②溶栓再通后Myo恢复正常时间最快,CTnI最迟(均P<0.01,表1)。
3 讨论
CTnI和Myo都是近年发展起来的新的心脏生化标记物[2],其中CTnI是心肌细胞收缩器的结构蛋白,是反映心肌损伤的高特异性指标[3],而Myo是心肌细胞的一种色素蛋白,在肌细胞中担负着载氧功能,也是心肌细胞损伤后较敏感的标记物[4]。我们的研究表明,在AMI患者中,Myo在胸痛后开始升高时间及达高峰时间较CK-MB和CTnI均早,但溶栓再通组Myo升高时间及达高峰时间较未溶栓组提前,并且溶栓组中Myo升高时间及达高峰时间也较CK-MB和CTnI早,作者观察到Myo最早的升高时间为胸痛后1.5 h,这与Ishii[5]报道相一致。Myo在血中出现时间早与其分子量很小、能迅速自缺血损伤部位释放进入血液循环有关,这一点非常有助于超急性期入院患者和溶栓后再灌注的及时诊断[5]。CTnI在AMI患者胸痛后升高时间于3组患者中均较CK-MB早,但3组患者中CTnI达高峰时间与CK-MB相比无显著性差异，而溶栓组CTnI升高时间及达高峰时间较未溶栓组提前,说明CTnI对AMI患者也有早期诊断价值。文献报道CTnI在AMI胸痛后4～6 h升高,16 h达高峰[6],与本文结果基本一致。CK-MB,CTnI及Myo 3种生化标记物,以Myo最早恢复正常,而以CTnI在血清中维持时间最长,约在10～12 d恢复正常,说明CTnI在心肌损伤后有一较长释放时间,在AMI发生1周后仍能在血清中检出而进一步明确诊断,这表明CTnI增加了AMI诊断的“时间窗”,与文献[3]报道一致。作者认为CK-MB,CTnI,Myo 3者组合能提高对AMI诊断的准确性,特别是对ECG无心肌梗死图形改变而疑为心肌梗死者、超急性期AMI、微小梗死灶的AMI以及非Q波性AMI的诊断，对AMI治疗后冠脉再灌注的及时判断均有重要价值。
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参考文献:
[1] 中华心血管杂志编委会. 急性心肌梗死溶栓疗法参考方案(1996年7月修订)[J]. 中华心血管病杂志,1996,24(5):328.
[2] Hamm CW. Katus HA. New biochemical markers for myocardial cell injure[J]. Current Opinion Cardiology,1995,10(4):355.
[3] Bodor GS,Porter S,Landt Y,et al. Development of monoclonal antibodies for an assay of cardiac troponin-I and preliminary results in suspected case of myocardial infarction[J]. Clin Chem,1992,38(11):2203.
, 百拇医药
[4] Uji Y,Okabe H,Sugiuchi H,et al. Measurement of serum myoglobin by a turbidimetric latex agglutination method[J]. J Clin Lab Analy,1992,6(1):7.
[5] Ishii J,Normura M,Ando T,et al. Early detection of successful coronary reperfusion based on serum myoglobin concentration:comparison with serum creatine kinase isoenzyme MB activity[J]. Am Heart J,1994,128(4):641.
[6] Mair J,Genser N,Morandell D,et al. Cardiac troponin I in the diagnosis of myocardial injure and infarction[J]. Clin Chem Acta,1996,245(1):19.
(收稿 1999-07-05 修回 1999-12-30), 百拇医药
单位：裴德安(无锡市第二人民医院心内科,江苏 无锡 214002)；徐默玲(无锡市第二人民医院心内科,江苏 无锡 214002)；郑义通(无锡市第二人民医院心内科,江苏 无锡 214002)；胡世文(无锡市第二人民医院心内科,江苏 无锡 214002)
关键词：肌酸激酶同功酶类；肌钙蛋白I；肌红蛋白；心肌梗死,急性
心脏杂志000413摘要:目的:比较心脏标记物肌钙蛋白I(CTnI),肌红蛋白(Myo)在急性心肌梗死(AMI)的动态变化,以探讨其诊断价值。方法:用固相双位点化学发光酶联免疫测定法测定了13例AMI患者(5例溶栓再通、8例未溶栓)CTnI,Myo并与CK-KB进行比较。结果:①溶栓与未溶栓组CTnI在AMI胸痛后升高时间较CK-MB早(均P<0.01),但以Myo升高时间最早;溶栓成功组CK-MB,CTnI和Myo升高时间均较未溶栓组提前(均P<0.05);②溶栓与未溶栓组Myo达高峰时间较CTnI和CK-MB均早(均P<0.01),但CTnI与CK-MB达高峰时间相比无显著性差异(P>0.05);溶栓再通组CK-MB,CTnI及Myo达高峰时间均较未溶栓组提前(均P<0.05)；③CK-MB,CTnI和Myo 3种生化标记物以Myo最早恢复正常,而以CTnI在血清中持续时间最长。结论:Myo和CTnI在AMI早期诊断中有应用价值,CK-MB,CTnI及Myo 3者结合可以提高对AMI诊断的准确性。
, http://www.100md.com
中图分类号:R542.22 文献标识码:A 文章编号:1005-3271(2000)04-0287-03
A comparative study on isoenzyme of serum creatin phosphokinase,cardiac troponin I and myoglobin concentration in patients with acute myocardial infarction
PEI De-an XU Mo-ling ZHENG Yi-tong HU Shi-wen
(Department of Cardiology,Second People′s Hospital of Wuxi,Wuxi Jiangsu 214002,China)
Abstract:AIM:To evaluate the diagnostic value of cardiac troponin I (CTnI) and myoglobin (Myo) in patients with acute myocardial infarction (AMI). METHODS:CTnI and CK-MB were detected with solid-phase two-site chemiluminescent enzyme immunometric assay and were compared with CK-MB in 13 patients with AMI (5 patients with thrombolysis and having successful reperfusion,8 patienrts without thrombolysis). RESULTS:① The detection of CTnI was earlier after the onest of chest pain than that of CK-MB (P<0.01), but the detection of Myo was earlier after the onset of pain than those of CK-MB activity and CTnI activity (P<0.01). The detections of CK-MB, CTnI and Myo were earlier in patients with thrombolytic treatment than those of CK-MB, CTnI and Myo respectively in patients without thrombolytic treatment. ②The time of the peak value of Myo occurs earlier than those of CTnI and CK-MB (P<0.01) in patients both with thrombolysis and without thrombolysis; but the time of peak value of CTnI and CK-MB had no significant deviation (P>0.05); The time of peak value of CK-MB, CTnI and Myo were earlier in patients with thrombolysis than that of CK-MB, CTnI and Myo respectively in patients without thrombolysis (P<0.05). ③The disappearance of Myo from the plasma after the onset of pain was earlier than those of CTnI and CK-MB in patients both with thrombolysis and without thrombolysis, and the CTnI ctivity disappearance from the plasma was latest in the three biochemical markers. CONCLUSION:The detection of Myo and CTnI is helpful in early diagnosis of AMI. We also conclude that the detection of the combination of CK-MB,CTnI and Myo can improve the accuracy of diagnosis in patients with AMI.
, 百拇医药
Key words:creatine kinase isoenzymes; troponin I;myoglobin;myocardial infarction,acute
磷酸肌酸激酶同功酶(CK-MB)是诊断急性心肌梗死(AMI)的重要指标,新的血清生化指标包括肌钙蛋白I(cardiac troponin I,CTnI)和肌红蛋白(myoglobin,Myo),据报道其敏感性和特异性均超过CK-MB。作者观察了血清CK-MB,CTnI及Myo在AMI患者中的动态变化,并进行对比研究,以探讨它们在AMI中的诊断价值。
1 对象和方法
1.1 对象 收集1999-01～1999-06 AMI患者13例,年龄48～82岁,平均63±11岁,其中5例行尿激酶溶栓治疗后再通,溶栓时间为胸痛后2.7±1.0 h,溶栓治疗用药方法与结果判断同文献[1],另8例未行溶栓治疗。AMI采血时间,在24 h内每3～4 h采血1次,以后于48,72,96 h各采血1次,再后为每1～2 d采血1次。
, 百拇医药
1.2 方法 ①用固相双位点化学发光酶联免疫测定法,抗体为抗心肌CTnI和Myo特异反应的单克隆抗体,化学发光底物为phosphate ester of adamantyl dioxetane,用 IMMULITE全自动分析仪(美国DPC公司)进行定量测定,质控血清CTnI批内CV 3.5%,批间CV 6.1%,Myo批内CV 2.6%,批间CV 7.2%。②CK-MB按德国临床化学学会(DKGC)推荐方法测定,试剂盒由上海申能生物技术公司提供。
1.3 统计学处理 所有数据以
±s表示,组间比较用t检验。2 结果
2.1 升高时间比较 ①CTnI在AMI胸痛后开始升高时间比CK-MB早(P<0.01),但Myo升高时间比前二者均早(均P<0.01)。②溶栓再通组CK-KB,CTnI及Myo升高时间均较未溶栓组早(均P<0.05);且溶栓再通组CTnI升高时间亦较CK-MB早(P<0.05),但Myo升高时间更早(均P<0.05,表1)。
, 百拇医药
表1 急性心肌梗死患者血清CK-MB,CTnI和Myo的变化比较(
±s，h)升高时间
高峰时间
恢复正常时间
组别
n
CK-MB
CTnI
Myo
CK-MB
CTnI
, 百拇医药
Myo
CK-MB
CTnI
Myo
全部
13
11.2±2.9b
7.1±1.7b
4.3±1.5b
20.0±8.9
16.1±3.0
10.5±4.4b
, 百拇医药
54±15b
264±50
36±13b
未溶栓
8
12.6±2.5b
8.0±1.2
5.1±1.1b
24.1±9.2
17.6±2.8
12.9±3.8b
, 百拇医药
58±16b
287±45
37±15b
溶栓再通
5
9.0±2.0a,c
5.7±1.4c
3.1±1.0a,c
13.4±1.5c
13.7±1.1c
, http://www.100md.com
6.7±2.0b,c
49±11b
227±33
34±8b
CK-MB:磷酸肌酸激酶同功酶;CTnI:肌钙蛋白I;Myo:肌红蛋白;同CTnI比较,aP<0.05,bP<0.01;与未溶栓比较,cP<0.05。2.2 高峰时间比较 ①Myo达高峰时间较CK-MB和CTnI均早(均P<0.01),但CTnI和CK-MB达高峰时间相差不显著(P>0.05)。②溶栓再通组CK-MB,CTnI及Myo达高峰时间均较未溶栓组提前(均P<0.05)。而溶栓再通后CK-MB达高峰时间与CTnI无显著差异(P>0.05),但Myo较CK-MB和CTnI均早(P<0.01,表1)。
, 百拇医药
2.3 恢复正常时间的比较 ①AMI患者CK-MB,CTnI及Myo 3种生化标记物以Myo首先恢复正常,而以CTnI最迟(均P<0.01);②溶栓再通后Myo恢复正常时间最快,CTnI最迟(均P<0.01,表1)。
3 讨论
CTnI和Myo都是近年发展起来的新的心脏生化标记物[2],其中CTnI是心肌细胞收缩器的结构蛋白,是反映心肌损伤的高特异性指标[3],而Myo是心肌细胞的一种色素蛋白,在肌细胞中担负着载氧功能,也是心肌细胞损伤后较敏感的标记物[4]。我们的研究表明,在AMI患者中,Myo在胸痛后开始升高时间及达高峰时间较CK-MB和CTnI均早,但溶栓再通组Myo升高时间及达高峰时间较未溶栓组提前,并且溶栓组中Myo升高时间及达高峰时间也较CK-MB和CTnI早,作者观察到Myo最早的升高时间为胸痛后1.5 h,这与Ishii[5]报道相一致。Myo在血中出现时间早与其分子量很小、能迅速自缺血损伤部位释放进入血液循环有关,这一点非常有助于超急性期入院患者和溶栓后再灌注的及时诊断[5]。CTnI在AMI患者胸痛后升高时间于3组患者中均较CK-MB早,但3组患者中CTnI达高峰时间与CK-MB相比无显著性差异，而溶栓组CTnI升高时间及达高峰时间较未溶栓组提前,说明CTnI对AMI患者也有早期诊断价值。文献报道CTnI在AMI胸痛后4～6 h升高,16 h达高峰[6],与本文结果基本一致。CK-MB,CTnI及Myo 3种生化标记物,以Myo最早恢复正常,而以CTnI在血清中维持时间最长,约在10～12 d恢复正常,说明CTnI在心肌损伤后有一较长释放时间,在AMI发生1周后仍能在血清中检出而进一步明确诊断,这表明CTnI增加了AMI诊断的“时间窗”,与文献[3]报道一致。作者认为CK-MB,CTnI,Myo 3者组合能提高对AMI诊断的准确性,特别是对ECG无心肌梗死图形改变而疑为心肌梗死者、超急性期AMI、微小梗死灶的AMI以及非Q波性AMI的诊断，对AMI治疗后冠脉再灌注的及时判断均有重要价值。
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(收稿 1999-07-05 修回 1999-12-30), 百拇医药