心肌梗死72小时后的肌钙蛋白的浓度与心肌梗死的面积以及微血管的阻塞相关

Troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction

来源：丁香园

摘要：

目的：研究的目的在心肌梗死后进行冠状动脉磁共振血管成像检查，以此为标准确定在心肌梗死中，评价心肌梗死的面积以及微血管的阻塞(MVO)，72小时的肌钙蛋白的测定是否比一系列CK浓度以及早时相的肌钙蛋白测定更为准确。

方法：在急性ST抬高和非ST抬高心肌梗死药物治疗后平均3.7±1.4天的时间做冠状动脉磁共振血管成像检查。测定心肌梗死的面积、微血管的阻塞(MVO)，并且测定与心肌梗死的面积、微血管的阻塞程度(MVO)相关的血清肌钙蛋白的浓度（分别留取心肌梗死后12小时和72小时的血样标本），以及一系列的CK的水平。

结果：93位患者进行了冠状动脉磁共振血管成像的检查，其中71位ST段抬高的患者接受了溶栓治疗，CK峰值，12小时肌钙蛋白浓度，以及72小时肌钙蛋白浓度都与冠状动脉磁共振血管成像检查测定的心肌梗死的面积有相关性（(r = 0.75, p<0.0001; r = 0.56, p = 0.0003; r = 0.62, p<0.0001 ).在存在微血管的阻塞(MVO)的实验组血清的生化指标比不存在微血管的阻塞(MVO)的实验组更高。（CK峰值：3085±1531 vs 1471±1135, p<0.001；12小时肌钙蛋白值: 58.3±46.9 vs 33.4±40.0, p = 0.13;72小时肌钙蛋白值：11.5±9.9 vs 5.5±4.6, p<0.005）。微血管的阻塞(MVO)的程度与12小时的肌钙蛋白值之间没有显著相关性(r = 0.16),而其他的血清生化指标则有相关性（CK的高峰值：r = 0.44, p<0.0001;72小时肌钙蛋白值r = 0.46, p = 0.0002)。

结论：心肌梗死72小时后简单的肌钙蛋白的测定与一系列CK测定的结果有相似性，它们在估计心肌梗死的面积、微血管的阻塞程度的方面优于心肌梗死后12小时测定的肌钙蛋白的浓度。

Troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction

ABSTRACT

Objectives: The aim of this study was to use late gadolinium hyper-enhancement cardiac magnetic resonance (LGE-CMR) imaging to determine if a 72-h troponin-I measurement would provide a more accurate estimation of infarct size and microvascular obstruction (MVO) than serial creatine kinase (CK) or early troponin-I values.

Methods: LGE-CMR was performed 3.7±1.4 days after medical treatment for acute ST elevation or non-ST elevation myocardial infarction. Infarct size and MVO were measured and correlated with serum troponin-I concentrations, which were sampled 12 h and 72 h after admission, in addition to serial CK levels.

Results: Ninety-three patients, of whom 71 had received thrombolysis for ST elevation myocardial infarction, completed the CMR study. Peak CK, 12-h troponin-I, and 72-h troponin-I were related to infarct size by LGE-CMR (r = 0.75, p<0.0001; r = 0.56, p = 0.0003; r = 0.62, p<0.0001 respectively). Serum biomarkers demonstrated higher values in the group with MVO compared with those without MVO (Peak CK 3085±1531 vs 1471±1135, p<0.001; 12-h troponin-I 58.3±46.9 vs 33.4±40.0, p = 0.13; 72-h troponin-I 11.5±9.9 vs 5.5±4.6, p<0.005). The correlation between the extent of MVO and 12-h troponin-I was not significant (r = 0.16), in contrast to the other serum biomarkers (peak CK r = 0.44, p<0.0001; 72-h troponin-I r = 0.46, p = 0.0002).

Conclusion: A single measurement of 72-h troponin-I is similar to serial CK measurements in the estimation of both myocardial infarct size and extent of MVO, and is superior to 12-h troponin-I measurements.