Jurlander B, Clemmensen P M, Ohman E M, Wagner G S, Grande P
Medicinsk afdeling B, Rigshospitalet, København.
Ugeskr Laeger. 1995 Jan 23;157(4):440-3.
Non-invasive methods for evaluation of intravenous thrombolytic treatment in patients with acute myocardial infarction (AMI) are needed, since approximately 30% of the patients never obtain coronary reperfusion. These patients could be candidates for additional thrombolytic treatment or acute PTCA. This study included 63 AMI patients. Intravenous and/or intracoronary thrombolysis was given to 52 patients, and 11 patients received conservative treatment (placebo). Serum myoglobin was measured every 15 min. Acute coronary angiography showed a patent coronary artery in 49 patients ("Reperfusion" group), and 14 patients had no coronary reperfusion ("No-Reperfusion" group). Mean time to peak serum myoglobin was 149 (57-194) minutes in the "Reperfusion" group and 476 (330-660) minutes in the "No-Reperfusion" group, p < 0.0001. An observed peak serum myoglobin < 5 hrs. after initiation of intravenous thrombolysis would indicate coronary reperfusion with sensitivity = 0.94; specificity = 0.79; predictive values of positive and negative test: 0.94 and 0.79, respectively. It is concluded that an peak serum myoglobin < five hrs. after start of thrombolysis predicts reperfusion status with a high level of accuracy.
由于约30%的急性心肌梗死（AMI）患者无法实现冠状动脉再灌注，因此需要非侵入性方法来评估AMI患者的静脉溶栓治疗效果。这些患者可能适合追加溶栓治疗或急性经皮冠状动脉腔内血管成形术（PTCA）。本研究纳入了63例AMI患者。52例患者接受了静脉和/或冠状动脉内溶栓治疗，11例患者接受了保守治疗（安慰剂）。每15分钟测量一次血清肌红蛋白。急性冠状动脉造影显示，49例患者的冠状动脉通畅（“再灌注”组），14例患者未实现冠状动脉再灌注（“无再灌注”组）。“再灌注”组血清肌红蛋白峰值出现的平均时间为149（57 - 194）分钟，“无再灌注”组为476（330 - 660）分钟，p < 0.0001。静脉溶栓开始后观察到血清肌红蛋白峰值< 5小时提示冠状动脉再灌注，敏感性 = 0.94；特异性 = 0.79；阳性和阴性试验预测值分别为0.94和0.79。结论是，溶栓开始后血清肌红蛋白峰值< 5小时对再灌注状态的预测具有较高的准确性。
