Stejskal D, Horalík D, Bartek J
Interní oddĕlení nemocnice Sternberk.
Vnitr Lek. 1998 Jul;44(7):391-5.
Acute myocardial infarction (AMI) is a disease with high morbidity and mortality. Diagnosis of AMI using common methods (classical biochemistry, ECG) fails even in the fifth part of patients so that other noninvasive diagnostic methods are preferred. Recently, the biochemical analysis has been restored in the case of AMI diagnostics and also in prediction of coronary reperfusion after administration of a fibrinolytic agent. A suitable markers of AMI diagnostics is a combination of myoglobin and cardial troponin-I which is reported as a marker with high specificity and sensitivity. To determine coronary reperfusion, the examination of cardial troponin-T and CK-MB mass is recommended. In the literature, there exist isolated papers dealing with dynamics of cTn-I suitable for prediction of coronary revascularization. However, these papers do not report any adequate algorithm and subsequently mathematical differences between successful thrombolysis and failing thrombolysis. Therefore the aim of our study was to describe dynamics of cTn-I changes in AMI patients treated by thrombolysis. The study comprised of 8 AMI patients with delay from the occurrence of pains to fibrinolysis application under 4 hours (delay 4 hrs). These probands were examined for concentration of cTn-I and CK-MB mass in 3-hour intervals in the first 48 hours after admission to the clinic and further in 6-hour intervals from the hour 48 to the hour 90 after admission. All probands had a successful reperfusion (estimated using CK-MB peak, in 4 patients reperfusion was verified by subsequent coronarography). However, a simple mathematical prediction of coronary reperfusion after acute myocardial infarction by means of cTn-I dynamics determination is not possible due to relatively low cTn-I differences in individual analyses (CK-MB mass analysis shows more significant differences). Thus, in order to determine coronary revascularization, we recommend to use common analyses of dynamics of cTn-T or CK-MB mass.
急性心肌梗死（AMI）是一种发病率和死亡率都很高的疾病。使用常规方法（经典生物化学、心电图）诊断AMI时，即使在五分之一的患者中也会失败，因此其他非侵入性诊断方法更受青睐。最近，生化分析在AMI诊断以及纤溶药物给药后冠状动脉再灌注的预测中又重新得到应用。AMI诊断的合适标志物是肌红蛋白和心肌肌钙蛋白I的组合，据报道该标志物具有高特异性和敏感性。为了确定冠状动脉再灌注，建议检测心肌肌钙蛋白T和CK-MB质量。在文献中，有一些孤立的论文涉及适用于预测冠状动脉血运重建的cTn-I动态变化。然而，这些论文没有报告任何合适的算法，也没有提及成功溶栓和溶栓失败之间的数学差异。因此，我们研究的目的是描述溶栓治疗的AMI患者中cTn-I变化的动态情况。该研究包括8例AMI患者，从疼痛发作到应用纤溶药物的延迟时间在4小时以内（延迟4小时）。这些受试者在入院后的前48小时内每3小时检测一次cTn-I和CK-MB质量，从入院后48小时到90小时每6小时检测一次。所有受试者均实现了成功再灌注（使用CK-MB峰值进行估计，4例患者的再灌注通过随后的冠状动脉造影得到证实）。然而，由于个体分析中cTn-I差异相对较小（CK-MB质量分析显示出更显著的差异），通过cTn-I动态测定对急性心肌梗死后冠状动脉再灌注进行简单的数学预测是不可能的。因此，为了确定冠状动脉血运重建，我们建议使用cTn-T或CK-MB质量动态的常规分析方法。
