Bertsch T, Resch S
Institut für Klinische Chemie, Universität Heidelberg.
Dtsch Med Wochenschr. 1995 Oct 13;120(41):1392-4. doi: 10.1055/s-2008-1055489.
A 30-year-old man in renal failure due to focal sclerosing glomerulonephritis was, after a seizure with subsequent rhabdomyolysis, found to have an increase not only of creatinekinase (CK) activity (> 100,000 U/l) but also of cardiac troponin T (cTnT) concentration in serum (13 micrograms/l; normal: < 0.1 microgram/l), in the absence of any cardiac symptoms.
Raised concentration of cTnT is known to occur in patients with renal failure but no cardiac symptoms. In our patient, despite increased creatinine levels, serum cTnT gradually fell to normal within 3 weeks, i.e. the raised creatinine played no part in the elevation of cTnT, which in this patient was probably due to crossreaction between cardiac and skeletal TnT, or transient fresh synthesis of cTnT in regenerating skeletal musculature.
In patients with extensive rhabdomyolysis and renal failure the assessment of the clinical status and the ECG, to exclude myocardial infarction, are of crucial importance. The cTnT level by itself is of only limited value in such cases.
一名30岁因局灶性硬化性肾小球肾炎导致肾衰竭的男性，在一次癫痫发作并继发横纹肌溶解后，不仅发现肌酸激酶（CK）活性升高（>100,000 U/l），而且血清中心肌肌钙蛋白T（cTnT）浓度也升高（13微克/升；正常：<0.1微克/升），且无任何心脏症状。
已知肾衰竭但无心脏症状的患者会出现cTnT浓度升高。在我们的患者中，尽管肌酐水平升高，但血清cTnT在3周内逐渐降至正常，即升高的肌酐对cTnT升高无作用，该患者cTnT升高可能是由于心肌和骨骼肌TnT之间的交叉反应，或再生骨骼肌组织中cTnT的短暂新合成。
在患有广泛横纹肌溶解和肾衰竭的患者中，评估临床状况和心电图以排除心肌梗死至关重要。在此类病例中，cTnT水平本身价值有限。
