Katus H A, Schoeppenthau M, Tanzeem A, Bauer H G, Saggau W, Diederich K W, Hagl S, Kuebler W
Abteilung Innere Medizin III, University of Heidelberg, Federal Republic of Germany.
Br Heart J. 1991 May;65(5):259-64. doi: 10.1136/hrt.65.5.259.
Troponin T is a unique cardiac antigen which is continuously released from infarcting myocardium. Its cardiospecificity as a marker protein might be particularly useful in assessing myocardial cell damage in patients undergoing cardiac surgery. Therefore, circulating troponin T was measured in serial blood samples from 56 patients undergoing cardiac surgery and in two control groups--22 patients undergoing minor orthopaedic surgery and 12 patients undergoing lung surgery by median sternotomy. In both control groups no troponin T could be detected, whereas activities of creatine kinase were raised in all 12 lung surgery controls and activities of the MB isoenzyme were raised in five of the 12 patients in the lung surgery group and in four of the 22 patients in the orthopaedic surgery group, respectively. All the patients undergoing coronary artery bypass grafting (n = 47) and cardiac surgery for other reasons (n = 9) had detectable concentrations of troponin T. Five patients had perioperative myocardial infarction detected as new Q waves and R wave reductions. In these five patients troponin T release persisted and serum concentrations (5.5-23 micrograms/l) reached a peak on the fourth postoperative day. In the 51 patients without perioperative myocardial infarction serum concentrations and the release kinetics of troponin T depended on the duration of cardiac arrest. In patients in whom aortic cross clamping was short troponin T increased slightly on the first postoperative days; in patients with longer periods of aortic cross clamping troponin T concentrations were higher and remained so beyond the fifth postoperative day. In patients with non-specific changes on the electrocardiogram troponin T concentrations were significantly higher on days 1 and 4 after operation than in patients with normal postoperative electrocardiograms(11.2 (5) and 4.5 (2.6) v 8.2 (3.4) and 2.9 (1.6) 1microg/l). Serum concentrations of troponin T showed some myocardial cell damage in every patient undergoing cardiac surgery. The persistent increases that were more common in patients with longer periods of cardiac arrest must have been caused by damage to the contractile apparatus. These results suggest that perioperative myocardial cell necrosis may be more common than indicated by changes of the QRS complex on the electrocardiogram.
肌钙蛋白T是一种独特的心脏抗原，它会从梗死的心肌中持续释放。其作为标记蛋白的心脏特异性在评估心脏手术患者的心肌细胞损伤方面可能特别有用。因此，我们对56例接受心脏手术的患者以及两个对照组——22例接受小型骨科手术的患者和12例通过正中胸骨切开术进行肺部手术的患者的系列血样进行了循环肌钙蛋白T的检测。在两个对照组中均未检测到肌钙蛋白T，而在所有12例肺部手术对照组中肌酸激酶活性升高，在肺部手术组的12例患者中有5例以及骨科手术组的22例患者中有4例肌酸激酶MB同工酶活性升高。所有接受冠状动脉搭桥术的患者（n = 47）以及因其他原因接受心脏手术的患者（n = 9）肌钙蛋白T浓度均可检测到。5例患者出现围手术期心肌梗死，表现为新的Q波和R波降低。在这5例患者中，肌钙蛋白T持续释放，血清浓度（5.5 - 23微克/升）在术后第4天达到峰值。在51例无围手术期心肌梗死的患者中，肌钙蛋白T的血清浓度和释放动力学取决于心脏停搏的持续时间。在主动脉交叉钳夹时间短的患者中，肌钙蛋白T在术后第1天略有升高；在主动脉交叉钳夹时间较长的患者中，肌钙蛋白T浓度更高且在术后第5天之后仍保持较高水平。在心电图有非特异性改变的患者中，术后第1天和第4天的肌钙蛋白T浓度显著高于术后心电图正常的患者（分别为11.2（5）和4.5（2.6）对8.2（3.4）和2.9（1.6）微克/升）。接受心脏手术的每例患者的血清肌钙蛋白T浓度均显示出一定程度的心肌细胞损伤。在心脏停搏时间较长的患者中更常见的持续升高必定是由收缩装置受损所致。这些结果表明，围手术期心肌细胞坏死可能比心电图QRS波群变化所显示的更为常见。
