Abe S, Arima S, Yamashita T, Miyata M, Okino H, Toda H, Nomoto K, Ueno M, Tahara M, Kiyonaga K
First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Japan.
J Am Coll Cardiol. 1994 May;23(6):1382-9. doi: 10.1016/0735-1097(94)90381-6.
The purpose of this study was to investigate the utility of cardiac troponin T for early assessment of reperfusion therapy.
Several biochemical markers are used for early noninvasive detection of reperfusion during intravenous thrombolytic therapy. However, cardiac troponin T, a new myocardial-specific marker, has not been used previously for this purpose.
We measured troponin T and creatine kinase, MB isoenzyme (CK-MB) levels in 38 patients with acute myocardial infarction whose infarct-related artery was totally occluded before reperfusion therapy. Subjects comprised 14 patients with successful angioplasty (group 1), 12 patients with successful thrombolytic therapy (group 2) and 12 patients with unsuccessful attempted reperfusion (group 3). Blood samples were taken every 15 min, and coronary angiography was performed every 5 to 8 min until 60 min after reperfusion (groups 1 and 2) or after the initiation of treatment (group 3). We calculated the increase in troponin T (delta troponin T) and CK-MB (delta CK-MB) 60 min after treatment was initiated and 60 min after reperfusion in groups 1 and 2.
Mean (+/- SD) delta troponin T and delta CK-MB levels were 9.35 +/- 7.83 ng/ml and 125 +/- 83 mU/ml in group 1 and 3.23 +/- 3.08 ng/ml and 130 +/- 137 mU/ml in group 2, respectively, 60 min after treatment and were 10.1 +/- 8.35 ng/ml and 131 +/- 84 mU/ml in group 1 and 6.84 +/- 8.30 ng/ml and 158 +/- 146 mU/ml in group 2, respectively, 60 min after reperfusion. These values were significantly higher than those 60 min after treatment in group 3: 0.16 +/- 0.19 ng/ml and 10 +/- 9 mU/ml, respectively. The predictive accuracy for detecting reperfusion using a threshold value of 0.50 ng/ml of delta troponin T and 25 mU/ml of delta CK-MB was 100% in group 1 and 92% in group 2 60 min after treatment, respectively. There was significant correlation between delta troponin T and delta CK-MB.
Serial measurements of cardiac troponin T as well as of CK-MB are useful for early assessment of reperfusion therapy.
本研究旨在探讨心肌肌钙蛋白T在再灌注治疗早期评估中的应用价值。
在静脉溶栓治疗期间，有几种生化标志物用于早期无创检测再灌注情况。然而，心肌肌钙蛋白T作为一种新的心肌特异性标志物，此前尚未用于此目的。
我们测量了38例急性心肌梗死患者在再灌注治疗前梗死相关动脉完全闭塞时的肌钙蛋白T和肌酸激酶同工酶MB（CK-MB）水平。受试者包括14例血管成形术成功的患者（第1组）、12例溶栓治疗成功的患者（第2组）和12例再灌注尝试失败的患者（第3组）。每隔15分钟采集一次血样，每隔5至8分钟进行一次冠状动脉造影，直至再灌注后60分钟（第1组和第2组）或治疗开始后（第3组）。我们计算了第1组和第2组治疗开始后60分钟以及再灌注后60分钟时肌钙蛋白T（肌钙蛋白T变化值）和CK-MB（CK-MB变化值）的升高情况。
第1组治疗60分钟后，肌钙蛋白T变化值和CK-MB变化值的平均（±标准差）分别为9.35±7.83 ng/ml和125±83 mU/ml；第2组分别为3.23±3.08 ng/ml和130±137 mU/ml。再灌注60分钟后，第1组分别为10.1±8.35 ng/ml和131±84 mU/ml；第2组分别为6.84±8.30 ng/ml和158±146 mU/ml。这些值显著高于第3组治疗60分钟后的数值：分别为0.16±0.19 ng/ml和10±9 mU/ml。治疗60分钟后，使用肌钙蛋白T变化值阈值0.50 ng/ml和CK-MB变化值阈值25 mU/ml检测再灌注的预测准确率在第1组为100%，在第2组为92%。肌钙蛋白T变化值与CK-MB变化值之间存在显著相关性。
连续测量心肌肌钙蛋白T以及CK-MB有助于再灌注治疗的早期评估。
