Séguin J R, Saussine M, Ferrière M, Léger J J, Léger J, Larue C, Calzolari C, Grolleau R, Chaptal P A
Thoracic and Cardiovascular Surgery, C.H.U. Hôpital Saint Eloi, Montpellier, France.
J Thorac Cardiovasc Surg. 1989 Sep;98(3):397-401.
Plasma levels of ventricular myosin fragments, determined with monoclonal antibodies to myosin heavy chains, were studied in 27 patients after cardiac operations (17 aorta-coronary bypass grafts and 10 valve replacements) to assess their possible role as a marker of perioperative myocardial necrosis. Five patients had perioperative myocardial necrosis after aorta-coronary bypass grafts as indicated by changes in the electrocardiogram and elevated levels of the MB isoenzyme of creatine kinase. Six more patients were also studied after thoracic operations performed by the same sternotomy approach. After cardiac operations, myosin levels increased from postoperative day 3 and reached peak values on day 7. Peak myosin values in patients with perioperative myocardial necrosis after aorta-coronary bypass grafting were significantly higher than in patients after an identical operation but without perioperative myocardial infarction (3793 +/- 592 versus 369 +/- 47 ng/ml; p less than 0.001). These results suggest that plasma myosin is a sensitive marker of myocardial necrosis. Furthermore, peak plasma levels of ventricular myosin after coronary bypass grafting without myocardial infarction (mean value 369 +/- 47 ng/ml) were not significantly different from peak levels after thoracic operations (mean value 253 +/- 52 ng/ml), whereas they were significantly higher after valve replacement (mean value 794 +/- 149 ng/ml; p less than 0.01). These results indicate that a certain degree of myocardial necrosis occurs during value replacement that is undetectable by the usual diagnostic criteria for perioperative myocardial infarction. We conclude that the plasma level of ventricular myosin fragments is a more specific and accurate marker of perioperative myocardial necrosis than changes in the electrocardiogram or elevated creatine kinase MB levels. Therefore the detection of myosin fragments, which appear in the serum on the third day after cardiac operations, may be useful for precise comparisons of different techniques of myocardial protection.
采用抗肌球蛋白重链单克隆抗体测定27例心脏手术后患者（17例行主动脉 - 冠状动脉搭桥术，10例行瓣膜置换术）的血浆心室肌球蛋白片段水平，以评估其作为围手术期心肌坏死标志物的可能作用。17例主动脉 - 冠状动脉搭桥术中，5例患者出现围手术期心肌坏死，表现为心电图改变及肌酸激酶MB同工酶水平升高。另外6例患者在采用相同胸骨切开术式的胸科手术后也进行了研究。心脏手术后，肌球蛋白水平从术后第3天开始升高，并在第7天达到峰值。主动脉 - 冠状动脉搭桥术后发生围手术期心肌坏死患者的肌球蛋白峰值显著高于相同手术但无围手术期心肌梗死的患者（3793±592对369±47 ng/ml；p＜0.001）。这些结果表明血浆肌球蛋白是心肌坏死的敏感标志物。此外，无心肌梗死的冠状动脉搭桥术后心室肌球蛋白的血浆峰值水平（平均值369±47 ng/ml）与胸科手术后的峰值水平（平均值253±52 ng/ml）无显著差异，而瓣膜置换术后则显著更高（平均值794±149 ng/ml；p＜0.01）。这些结果表明在瓣膜置换过程中发生了一定程度的心肌坏死，而这通过围手术期心肌梗死的常规诊断标准无法检测到。我们得出结论，与心电图改变或肌酸激酶MB水平升高相比，血浆心室肌球蛋白片段水平是围手术期心肌坏死更特异、准确的标志物。因此，检测心脏手术后第3天出现在血清中的肌球蛋白片段，可能有助于精确比较不同的心肌保护技术。
