Koshkina E V, Krasnosel'skiĭ M Ia, Fedorovskiĭ N M, Goriacheva E V, Polupan A A, Aref'ev A A, Katrukha A G
Anesteziol Reanimatol. 2009 Nov-Dec(6):42-6.
There are presently reports on elevated levels of cardiac troponins in patients without acute myocardial infarction (AMI). The objective of this investigation was to study the diagnostic value of increased blood cardiac troponin T levels in patients without its clinical picture and ECG changes characteristic of AMI. The study covered 72 patients (48 males and 24 females) aged 54 to 87 years (mean 69.8 +/- 11.2 years). The inclusion criteria were increased cardiac troponin T; the main exclusion criteria were AMI-typical anginal pain and characteristic ECG changes (ST-segment elevation, the appearance of pathological Q waves). The final diagnosis of AMI was established in only 29 (40.3%) patients; the other 43 patients were diagnosed as having the following diseases: septic state in 21; oncopathology in 10; diabetic nephropathy with chronic renal failure in 6; brain infarct in 4; and B12 deficiency anemia in 2. In dead patients, the level of troponin T was significantly higher than that in discharged patients, respective of the underlying disease. There was a direct correlation between the cardiac troponin T levels and the SAPS II index that reflected the severity of a patient's general condition (r = 0.44; p = 0.0001) and an inverse correlation between the cardiac troponin level and the left ventricular ejection fraction (r = -0.45; p = 0.003). Thus, despite the cardiospecificity of troponin T, its detection in the blood of critically ill patients without other manifestations of AMI is not a specific symptom of AMI, but it is suggestive of the severity of the disease, probably with the involvement of the myocardium into the pathological process.
目前有关于无急性心肌梗死（AMI）患者心脏肌钙蛋白水平升高的报道。本研究的目的是探讨在无AMI临床表现及心电图改变的患者中，血中心脏肌钙蛋白T水平升高的诊断价值。该研究纳入了72例年龄在54至87岁（平均69.8±11.2岁）的患者（48例男性和24例女性）。纳入标准为心脏肌钙蛋白T升高；主要排除标准为AMI典型的心绞痛及特征性心电图改变（ST段抬高、病理性Q波出现）。最终仅29例（40.3%）患者被确诊为AMI；其他43例患者被诊断为以下疾病：21例为脓毒症状态；10例为肿瘤病理学；6例为糖尿病肾病伴慢性肾衰竭；4例为脑梗死；2例为维生素B12缺乏性贫血。在死亡患者中，无论基础疾病如何，肌钙蛋白T水平均显著高于出院患者。心脏肌钙蛋白T水平与反映患者总体病情严重程度的SAPS II指数呈直接相关（r = 0.44；p = 0.0001），与左心室射血分数呈负相关（r = -0.45；p = 0.003）。因此，尽管肌钙蛋白T具有心肌特异性，但在无AMI其他表现的危重症患者血液中检测到它并非AMI的特异性症状，而是提示疾病的严重程度，可能心肌已参与到病理过程中。
