经皮冠状动脉腔内成形术后血清肌钙蛋白I的变化及意义的研究(摘要)
作者：刘日辉 曲新凯 方唯一 宋道岭 刘欣
单位：辽宁省，辽阳市第三人民医院 心内科(111000) 刘日辉； 大连医科大学附属第一医院 心内科 曲新凯 方唯一 宋道岭； 鞍钢铁西医院 心内科 刘 欣
关键词：
中国循环杂志99zk33 目的：血清肌钙蛋白I(cTnI)对诊断心肌损伤有很高的特异性和敏感性，通过cTnI、肌酸激酶及其同工酶MB(CK-MB activity)及心电图(ECG)监测其在经皮冠状动脉腔内成形术(PTCA)术前、术后的变化，探讨PTCA术后残留心绞痛的原因。
方法：选择在1998年3月～1999年4月期间，63例行PTCA术及支架置入术的患者，其中择期57例，急诊6例，分别在术前、术后6 h、10 h、24 h、48 h取血测cTnI及CK-MB activity。择期组选择术前CK-MB、cTnI正常者。在术中密切观察心电图、动脉压等指标。结果用统计软件SPSS7.5进行数据分析。
, http://www.100md.com
结果：63例患者中，术后残留心绞痛者有13例，其中择期组有10例(17.54%,10/57)，急诊组有3例(50.0%,3/6)。术后残留心绞痛者伴有并发症(栓塞或闭塞)占61.5%(8/13),伴残留狭窄占46.2%(6/13),与无残留心绞痛相比差异有显著性(P>0.05)。择期组中，10例残留心绞痛患者，2例cTnI、CK-MB均升高，为D1支闭塞；5例仅cTnI升高，其中1例D2支闭塞，微小栓塞1例，内膜损伤及夹层3例；3例cTnI正常，其中1例见少量心包积液，另2例是扩张左主干及前降支开口，术中无并发症。急诊组中有3例术后仍持续有心绞痛，其中2例为再闭塞，另1例为D1闭塞。cTnI升高组(39.7%，25/63)中发现cTnI升高与PTCA术中总扩张次数、总扩张时间呈正相关。63例中术后有微小心肌损伤者(cTnI升高、CK-MB activity正常)20例。此外，发现扩张完全闭塞的右冠状动脉时，有6例(6/20)V4～6导联上有轻度缺血改变，此6例有5例cTnI轻度升高，CK-MB活性正常。此组患者冠状动脉造影的特点是：右冠血流再通、前向血流稍延缓、左冠至右冠的侧枝循环消失。
, 百拇医药
结论：本文观察发现，PTCA及支架置入术后，残留心绞痛者大多伴有cTnI升高，主要是由于血管再闭塞、侧枝闭塞、栓塞等。PTCA术后有微小损伤的存在，cTnI测定可以了解损伤程度、判断预后。cTnI升高同术中总扩张时间、总扩张次数呈正相关。在PTCA及支架置入术中有再灌注损伤和心肌钝抑的存在。PTCA术后监测肌钙蛋白I是有意义。
The Prognostic Value of Troponin I Release after Percutaneous Transluminal Coronary Angioplasty (Abstract)
Department of Cardiology, The Third People′s Hospital of Liaoyang, Liaoyang (111000), Liaoning
Liu Rihui, Qu Xingkai, Fang Weiyi, et al.
, 百拇医药
Objective: Percutaneous transluminal coronary angioplasty (PTCA) has become the most popular invasive procedure for myocardial revascularization. Insistant cheat pain is a main symptom for some patitnets after coronary balloon dilatation or stenting. To study the myocardial damage during PTCA. We examined the relations of elevated cardial troponin I (cTnI), MB isoenzyme of creatime kinase (CK-MB) activity and the change of electrocardiolgram (ECG) before, during and after PTCA.
, 百拇医药
Methods: In 57 consecutive patients undergoing non-emergency PTCA and 6 patients undergoing emergency PTCA the cTnI and CK-MB activity were measured before and 6, 10, 24 and 48 hours after procedure, and the ECG was taken simultaneously.
Results: Ten patients (17.54%, 10/57) in non-emergency PTCA group and 3 patients (50%, 3/6) in emergency PTCA group had remaining angina after PTCA. Most patients with remaining angina were associated with procedure complications (intimal dissection, coronary embolization and side-branch occlusion, 61.5%, 8/13) and with residueal stenosis (46.2%, 6/13). A significent increase of cTnI and CK-MB was seen in 2 patients non-emergency PTCA group. Among the subgroup, 2 occured coronary occlusion, 1 D1 occlusion induced by PTCA. The increased levels of cTnI were significantly correlated with the total baloon inflation time (p<0.05). 20 patients had minor myocardial damage (MMD) with slightly elevated cTnI but without increase of CK-MB activity. In 6 patients, their T wave was reversed in V4-6 after RCA dilatation or stenting and remained the increase for 48 hours. Although their RCA was reopened and coronary flow recovered to TIMI 3. In 6 cases the collateral circulation from left to right coronary disappeared.
, http://www.100md.com
Conclusions: Our study showed that the patients with remaining angina often have cTnI increasing after PTCA. The reasons are the abrupt occlusion, distal coronary folw obstruction (including collateral circulation disappearing) intimal dissection and side-branch occlusion. cTnI measurement may be beneficial for assessing the degree of myocardial damage. So cTnI level is a sensitive marker for evaluating coronary flow recovery and myocardial ischemia after PTCA., http://www.100md.com
单位：辽宁省，辽阳市第三人民医院 心内科(111000) 刘日辉； 大连医科大学附属第一医院 心内科 曲新凯 方唯一 宋道岭； 鞍钢铁西医院 心内科 刘 欣
关键词：
中国循环杂志99zk33 目的：血清肌钙蛋白I(cTnI)对诊断心肌损伤有很高的特异性和敏感性，通过cTnI、肌酸激酶及其同工酶MB(CK-MB activity)及心电图(ECG)监测其在经皮冠状动脉腔内成形术(PTCA)术前、术后的变化，探讨PTCA术后残留心绞痛的原因。
方法：选择在1998年3月～1999年4月期间，63例行PTCA术及支架置入术的患者，其中择期57例，急诊6例，分别在术前、术后6 h、10 h、24 h、48 h取血测cTnI及CK-MB activity。择期组选择术前CK-MB、cTnI正常者。在术中密切观察心电图、动脉压等指标。结果用统计软件SPSS7.5进行数据分析。
, http://www.100md.com
结果：63例患者中，术后残留心绞痛者有13例，其中择期组有10例(17.54%,10/57)，急诊组有3例(50.0%,3/6)。术后残留心绞痛者伴有并发症(栓塞或闭塞)占61.5%(8/13),伴残留狭窄占46.2%(6/13),与无残留心绞痛相比差异有显著性(P>0.05)。择期组中，10例残留心绞痛患者，2例cTnI、CK-MB均升高，为D1支闭塞；5例仅cTnI升高，其中1例D2支闭塞，微小栓塞1例，内膜损伤及夹层3例；3例cTnI正常，其中1例见少量心包积液，另2例是扩张左主干及前降支开口，术中无并发症。急诊组中有3例术后仍持续有心绞痛，其中2例为再闭塞，另1例为D1闭塞。cTnI升高组(39.7%，25/63)中发现cTnI升高与PTCA术中总扩张次数、总扩张时间呈正相关。63例中术后有微小心肌损伤者(cTnI升高、CK-MB activity正常)20例。此外，发现扩张完全闭塞的右冠状动脉时，有6例(6/20)V4～6导联上有轻度缺血改变，此6例有5例cTnI轻度升高，CK-MB活性正常。此组患者冠状动脉造影的特点是：右冠血流再通、前向血流稍延缓、左冠至右冠的侧枝循环消失。
, 百拇医药
结论：本文观察发现，PTCA及支架置入术后，残留心绞痛者大多伴有cTnI升高，主要是由于血管再闭塞、侧枝闭塞、栓塞等。PTCA术后有微小损伤的存在，cTnI测定可以了解损伤程度、判断预后。cTnI升高同术中总扩张时间、总扩张次数呈正相关。在PTCA及支架置入术中有再灌注损伤和心肌钝抑的存在。PTCA术后监测肌钙蛋白I是有意义。
The Prognostic Value of Troponin I Release after Percutaneous Transluminal Coronary Angioplasty (Abstract)
Department of Cardiology, The Third People′s Hospital of Liaoyang, Liaoyang (111000), Liaoning
Liu Rihui, Qu Xingkai, Fang Weiyi, et al.
, 百拇医药
Objective: Percutaneous transluminal coronary angioplasty (PTCA) has become the most popular invasive procedure for myocardial revascularization. Insistant cheat pain is a main symptom for some patitnets after coronary balloon dilatation or stenting. To study the myocardial damage during PTCA. We examined the relations of elevated cardial troponin I (cTnI), MB isoenzyme of creatime kinase (CK-MB) activity and the change of electrocardiolgram (ECG) before, during and after PTCA.
, 百拇医药
Methods: In 57 consecutive patients undergoing non-emergency PTCA and 6 patients undergoing emergency PTCA the cTnI and CK-MB activity were measured before and 6, 10, 24 and 48 hours after procedure, and the ECG was taken simultaneously.
Results: Ten patients (17.54%, 10/57) in non-emergency PTCA group and 3 patients (50%, 3/6) in emergency PTCA group had remaining angina after PTCA. Most patients with remaining angina were associated with procedure complications (intimal dissection, coronary embolization and side-branch occlusion, 61.5%, 8/13) and with residueal stenosis (46.2%, 6/13). A significent increase of cTnI and CK-MB was seen in 2 patients non-emergency PTCA group. Among the subgroup, 2 occured coronary occlusion, 1 D1 occlusion induced by PTCA. The increased levels of cTnI were significantly correlated with the total baloon inflation time (p<0.05). 20 patients had minor myocardial damage (MMD) with slightly elevated cTnI but without increase of CK-MB activity. In 6 patients, their T wave was reversed in V4-6 after RCA dilatation or stenting and remained the increase for 48 hours. Although their RCA was reopened and coronary flow recovered to TIMI 3. In 6 cases the collateral circulation from left to right coronary disappeared.
, http://www.100md.com
Conclusions: Our study showed that the patients with remaining angina often have cTnI increasing after PTCA. The reasons are the abrupt occlusion, distal coronary folw obstruction (including collateral circulation disappearing) intimal dissection and side-branch occlusion. cTnI measurement may be beneficial for assessing the degree of myocardial damage. So cTnI level is a sensitive marker for evaluating coronary flow recovery and myocardial ischemia after PTCA., http://www.100md.com