Koukkunen H, Penttilä K, Kemppainen A, Halinen M, Penttilä I, Rantanen T, Pyörälä K
Department of Medicine, Kuopio University Hospital, Finland.
Ann Med. 1998 Oct;30(5):488-96. doi: 10.3109/07853899809002491.
The aim of this study was to compare troponin T (TnT) and creatine kinase isoenzyme MB mass (CK-MBm) with conventional enzymes, ie CK, CK-MB activity and lactate dehydrogenase isoenzyme 1, in the diagnosis of myocardial infarction (MI). 624 patients (351 men and 273 women, median age 69 years) were admitted to hospital with suspicion of an acute coronary heart disease event. TnT was elevated (> 0.10 microg/L) in 100%, CK-MBm (> 5.0 microg/L) in 99%, and both markers in 99% of the 89 patients with the diagnosis of a definite MI according to modified FINMONICA criteria. In the 60 patients with the diagnosis of a probable MI, TnT was elevated in 65%, CK-MBm in 67% and both markers in 60%. In the patients with unstable coronary artery disease (unstable angina or prolonged chest pain attack) and conventional enzymes within normal limits, TnT was elevated in 14%, CK-MBm in 17% and both markers in 9%. The use of TnT and CK-MBm did not lead to a major change in the diagnostics of definite MI. However, TnT and CK-MBm did not confirm the diagnosis of probable MI in one-third of the events. These new markers revealed a myocardial injury in about 15% of those patients who had unstable coronary artery disease and conventional enzymes within normal limits.
本研究旨在比较肌钙蛋白T（TnT）和肌酸激酶同工酶MB质量（CK-MBm）与传统酶类，即肌酸激酶（CK）、CK-MB活性及乳酸脱氢酶同工酶1，在诊断心肌梗死（MI）中的作用。624例患者（351例男性，273例女性，中位年龄69岁）因疑似急性冠心病事件入院。根据改良的芬兰MONICA标准，在确诊为明确MI的89例患者中，TnT升高（>0.10μg/L）的占100%，CK-MBm升高（>5.0μg/L）的占99%，两种标志物均升高的占99%。在诊断为可能MI的60例患者中，TnT升高的占65%，CK-MBm升高的占67%，两种标志物均升高的占60%。在冠状动脉疾病不稳定（不稳定型心绞痛或胸痛发作持续时间较长）且传统酶类在正常范围内的患者中，TnT升高的占14%，CK-MBm升高的占17%，两种标志物均升高的占9%。使用TnT和CK-MBm并未导致明确MI诊断的重大改变。然而，在三分之一的病例中，TnT和CK-MBm并未证实可能MI的诊断。这些新标志物在约15%冠状动脉疾病不稳定且传统酶类在正常范围内的患者中显示出心肌损伤。
