Apple F S, Henry T D, Berger C R, Landt Y A
Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis, USA.
Am J Clin Pathol. 1996 Jan;105(1):6-10. doi: 10.1093/ajcp/105.1.6.
The authors report the use of cardiac troponin I (cTnI) for the early, noninvasive determination of coronary reperfusion following thrombolytic therapy. Cardiac troponin I, creatine kinase (CK)-MB, and myoglobin concentrations were measured in early serum specimens at 30, 60, and 90 minutes after initiation of therapy (0 minutes) in 25 consecutive patients given front-loaded rt-PA during acute myocardial infarction. Angiography, determined at 90 minutes after therapy, was used to classify patients as follows: group I (n = 17) reperfusion (TIMI flow grade 2, 3); and group 2 (n = 8) absence of reperfusion (TIMI flow grade 0, 1). The authors calculated the ratio increase in cTnI (delta cTnI), CK-MB (delta CK-MB), and myoglobin (delta myoglobin) 90 minutes after therapy in group 1 and 2. Serum cTnI, CK-MB and myoglobin concentrations significantly increased at 60 and 90 minutes in group 1, but not in group 2. Delta cTnI, delta CK-MB, and delta myoglobin levels were significantly increased in group 1 versus group 2 at 90 minutes. Further, delta cTnI was significantly greater at 90 minutes within group 1 compared to delta CK-MB and delta myoglobin. The sensitivity for detecting reperfusion at 90 minutes angiography using threshold values of 6.0 for delta cTnI, 7.0 for delta CK-MB, and 5.0 for delta myoglobin were: delta cTnI 82.4%; delta CK-MB 64.7%; delta myoglobin 76.5%; respectively. This study indicates that early serial measurements of cTnI were a more accurate predictor of early coronary artery reperfusion 90 minutes after thrombolytic therapy compared to CK-MB and myoglobin. Larger population studies will be necessary to confirm these finding.
作者报告了使用心肌肌钙蛋白I（cTnI）对溶栓治疗后冠状动脉再灌注进行早期、非侵入性测定的情况。在25例急性心肌梗死期间接受负荷剂量重组组织型纤溶酶原激活剂（rt-PA）治疗的连续患者中，于治疗开始后（0分钟）30、60和90分钟采集早期血清标本，测定心肌肌钙蛋白I、肌酸激酶（CK）-MB和肌红蛋白浓度。在治疗后90分钟进行血管造影，据此将患者分为以下两组：第一组（n = 17）再灌注（TIMI血流分级2、3级）；第二组（n = 8）无再灌注（TIMI血流分级0、1级）。作者计算了第一组和第二组患者治疗后90分钟时cTnI（ΔcTnI）、CK-MB（ΔCK-MB）和肌红蛋白（Δ肌红蛋白）的升高比值。第一组患者在60和90分钟时血清cTnI、CK-MB和肌红蛋白浓度显著升高，而第二组则未升高。在90分钟时，第一组的ΔcTnI、ΔCK-MB和Δ肌红蛋白水平显著高于第二组。此外，与ΔCK-MB和Δ肌红蛋白相比，第一组在90分钟时的ΔcTnI显著更高。使用ΔcTnI阈值6.0、ΔCK-MB阈值7.0和Δ肌红蛋白阈值5.0检测90分钟血管造影时再灌注的敏感性分别为：ΔcTnI 82.4%；ΔCK-MB 64.7%；Δ肌红蛋白76.5%。这项研究表明，与CK-MB和肌红蛋白相比，早期连续测量cTnI是溶栓治疗后90分钟时早期冠状动脉再灌注更准确的预测指标。需要更大规模的人群研究来证实这些发现。
