Remppis A, Scheffold T, Karrer O, Zehelein J, Hamm C, Grünig E, Bode C, Kübler W, Katus H A
Innere Medizin, University of Heidelberg, Germany.
Br Heart J. 1994 Mar;71(3):242-8. doi: 10.1136/hrt.71.3.242.
The purpose of this study was to derive indices of reperfusion and non-reperfusion after acute myocardial infarction (AMI) from changes in serum concentrations of cardiac troponin T and to test the predictive value of these indices.
The indices were derived from a retrospective analysis of changes in serum troponin T concentration in 71 patients given thrombolytic treatment who had immediate and late angiography (group 1). These troponin T indices were first tested in a blinded and prospective study of 53 consecutive patients eligible for thrombolytic therapy (group 2). They were then used for the non-invasive assessment of reperfusion of AMI in 48 patients (group 3).
In group 1 troponin T serum concentration curves were biphasic in patients who had reperfusion < or = 5.8 h after the onset of symptoms. Release of the cytosolic troponin T pool resulted in a peak at 14 h and ended at 38 h. The probability of reperfusion was > 95% when the ratio of peak cytosolic troponin T concentration to concentration at 38 h (PV1/38) exceeded 1.42 or the ratio of troponin T concentration at 14 h to that at 38 hours (14/38) exceeded 1.09. The probability of the presence of non-reperfused AMI was < 5% when troponin T PV1/38 and 14/38 ratios were < 0.99 and < 0.84 respectively. These discriminatory values of troponin T indices correctly classified (efficiency 96%) 48 of the 53 group 2 patients in whom immediate and late angiography were performed. When troponin T indices were used to classify 48 group 3 patients who were not studied by immediate angiography, thrombolytic therapy was deemed to have been successful in 82% of the treated patients, with spontaneous recanalisation in 11% and 23% of the non-treated patients assessed by PV1/38 and 14/38 respectively.
The PV1/38 or 14/38 ratios of serum troponin T concentration indicated the effectiveness of thrombolytic therapy in achieving reperfusion of AMI.
本研究旨在通过心肌肌钙蛋白T血清浓度变化得出急性心肌梗死（AMI）再灌注和未再灌注指标，并检验这些指标的预测价值。
这些指标来自对71例接受溶栓治疗且进行了即刻和延迟血管造影的患者（第1组）血清肌钙蛋白T浓度变化的回顾性分析。这些肌钙蛋白T指标首先在一项对53例符合溶栓治疗条件的连续患者进行的盲法前瞻性研究（第2组）中进行检验。然后将其用于对48例患者（第3组）急性心肌梗死再灌注的无创评估。
在第1组中，症状发作后再灌注时间≤5.8小时的患者，肌钙蛋白T血清浓度曲线呈双相性。细胞溶质肌钙蛋白T池的释放导致在14小时出现峰值，并在38小时结束。当细胞溶质肌钙蛋白T峰值浓度与38小时浓度之比（PV1/38）超过1.42或14小时肌钙蛋白T浓度与38小时浓度之比（14/38）超过1.09时，再灌注概率>95%。当肌钙蛋白T的PV1/38和14/38比值分别<0.99和<0.84时，未再灌注急性心肌梗死的概率<5%。这些肌钙蛋白T指标的鉴别值正确分类（效率96%）了第2组中53例进行了即刻和延迟血管造影的患者中的48例。当使用肌钙蛋白T指标对48例未进行即刻血管造影研究的第3组患者进行分类时，82%接受治疗的患者被认为溶栓治疗成功，通过PV1/38和14/38分别评估，未治疗患者中有11%和23%出现自发再通。
血清肌钙蛋白T浓度的PV1/38或14/38比值表明了溶栓治疗实现急性心肌梗死再灌注的有效性。
