心肌肌钙蛋白Ⅰ临床应用进展

心肌肌钙蛋白I(Cardiac Troponin I,cTnI)作为诊断心肌损伤的血清标志物之一,同其它检测指标相比,具有出现时间早、诊断窗口期宽、特异性强、诊断阈值明确及检测快速等优点。由于心肌肌钙蛋白I为心肌细胞所特有,因此在心肌缺血性损伤、心肌非缺血性损害的诊断及骨骼肌损伤的鉴别诊断中得到了广泛应用。目前正逐渐取代包括CK-MB在内的其它血清酶检测指标而成为判断心肌损伤,特别是诊断急性心肌梗死(Acute Myocardial Infarction.AMI)的"金标准"。同时心肌肌钙蛋白I对心肌疾病的病情监测、疗效观察及预后评估都具有较高的临床应用价值。本文对cTnI的国内外临床应用研究进展进行综述。     

急性心肌梗死患者血清外连素、MEG3、HSP-70水平与心肌损伤标志物及心血管不良事件的关系研究

目的:研究急性心肌梗死(AMI)患者血清外连素、母系表达基因3(MEG3)、热休克蛋白70(HSP-70)水平与心肌损伤标志物及心血管不良事件的关系。方法:选取2015年1月-2020年1月期间我院接受治疗的AMI患者200例作为AMI组,另选取同期在我院健康体检的人群100例作为对照组,对比对照组、AMI组心肌型肌酸激酶同工酶(CK-MB)、肌红蛋白(Myo)、心肌肌钙蛋白Ⅰ(cTnI)、外连素、MEG3 RNA、HSP-70。对比心血管不良事件与非心血管不良事件患者的CK-MB、Myo、cTnI、外连素、MEG3 RNA、HSP-70水平。采用Pearson相关性分析AMI患者血清外连素、MEG3 RNA、HSP-70水平与心肌损伤标志物的关系。结果:AMI组CK-MB、Myo、cTnI、外连素、MEG3 RNA、HSP-70均高于对照组(P<0.05)。随访过程中,有59例发生心血管不良事件纳为心血管不良事件组,剩余141例未发生心血管不良事件纳为非心血管不良事件组。心血管不良事件组患者的CK-MB、Myo、cTnI、外连素、MEG3 RNA、HSP-70均高于非心血管不良事件组(P<0.05)。AMI患者外连素、MEG3 RNA、HSP-70水平与CK-MB、Myo、cTnI均呈正相关(P<0.05)。结论:AMI患者中外连素、MEG3 RNA、HSP-70均呈现异常高表达,且与心肌损伤标志物密切相关,可考虑作为AMI患者早期确诊的新型标志物。     

CK-MBmass, hs-cTnT及CK-MB与急性心肌梗死的相关性及其联合诊断价值

摘要 目的：研究肌酸激酶同工酶质量（CK-MBmass)、肌酸激酶同工酶（CK-MB）和高敏心肌肌钙蛋白T（hs-cTnT）在急性心肌梗死患者（AMI）血清中的含量,并探讨三者联合对AMIDE诊断价值。方法：选择2018年1月到2021年10月我院收治的AMI患者90例作为研究组,并选择同期在我院体检健康志愿者40例作为对照组,比较两组AMI患者血清CK-MBmass,hs-cTnT和CK-MB。根据Killp分级法将不同心力衰竭将AMI患者分为II、III和IV级,并根据心肌梗死范围将AMI患者分为轻度、中度和重度心肌梗死组。比较不同AMI患者血清CK-MBmass,hs-cTnT和CK-MB。通过受试者工作曲线计算血清CK-MBmass,hs-cTnT和CK-MB联合诊断AMI的阳性预测值、阴性预测值、敏感度和特异度。结果：（1）AMI患者血清CK-MBmass,hs-cTnT和CK-MB均显著高于健康志愿者（P<0.05）;（2）AMI患者血清CK-MBmass,hs-cTnT和CK-MB随Killp分级或心肌梗死范围升高而升高（P<0.05）;（3）AMI患者血清CK-MBmass,hs-cTnT,CK-MB与急性心肌梗死患者左室射血分数（LVEF）呈负相关（P<0.05）,与左室舒张末期容积（LVEDd）和梗死范围呈正相关（P<0.05）;（4）血清CK-MBmass,hs-cTnT和CK-MB联合检测急性心肌梗死的阳性预测值、阴性预测值、敏感度和特异度均高于单独诊断。结论：血清CK-MBmass,hs-cTnT和CK-MB在AMI患者含量升高,并且与患者心功能和心肌梗死范围有关,适用于AMI的联合诊断。     

急诊超声心动图联合血清NT-proBNP、cTnI、CK-MB诊断急性心肌梗死的临床价值分析

摘要 目的：研究急诊超声心动图联合血清氨基末端脑钠肽前体（NT-proBNP）、肌钙蛋白（cTnI）和肌酸激酶同工酶（CK-MB）诊断急性心肌梗死（AMI）的临床价值。方法：将2019年12月至2020年6月期间我院收治的82例AMI患者纳入研究,记作病变组。另取同期于我院进行体检的健康者80例作为对照组。比较两组各项超声心动图指标水平,血清NT-proBNP、cTnI和CK-MB水平。分析超声心动图指标与血清NT-proBNP、cTnI和CK-MB的相关性。以受试者工作特征（ROC）曲线分析超声心动图联合血清NT-proBNP、cTnI和CK-MB水平诊断AMI的效能。结果：病变组左心室射血分数（LVEF）低于对照组,而左室舒张末期内径（LVEDD）高于对照组（P＜0.05）。病变组血清NT-proBNP、cTnI和CK-MB水平均高于对照组（P＜0.05）。Pearson检验显示LVEF与血清NT-proBNP、cTnI和CK-MB均呈负相关（r=-0.514、-0.578、-0.532,均P＜0.05）,LVEDD与血清NT-proBNP、cTnI和CK-MB均呈正相关（r=0.625、0.594、0.575,均P＜0.05）。超声心动图联合血清三项诊断AMI的曲线下面积、灵敏度以及特异度均高于超声心动图、血清三项单独诊断。结论：超声心动图联合血清NT-proBNP、cTnI和CK-MB诊断AMI的价值较高,具有一定的临床应用价值。     

PCI术前AMI伴左心衰竭患者死亡的高危因素分析

目的:探讨PCI术前AMI伴左心衰竭患者死亡的高危因素.方法:回顾总结53例AMI伴左心衰患者,其中包括13例死亡病例.40例行PCI术的存活病例为对照组.将其临床特征及入院24小时内检测的血红蛋白(Hb)、血肌酐(Cr)、血氧饱和度(SaO2)、心肌坏死标志物,包括肌红蛋白(MYO),肌酸激酶同工酶(CK-MB),肌钙蛋白I(cTnI)和部分神经内分泌指标,包括肾素活性(PRA),血管紧张素Ⅱ(AngⅡ),醛固酮(ALD),肾上腺素(E).去甲肾上腺素(NE)进行对比研究.结果:死亡组在年龄、性别、Hb、Cr、SaO2、CK-MB、eTnI方面与存活组比较差别有显著性(P<0.05).结论:年龄偏大,多合并高血压病和糖尿病,早期发生低氧血症,以多支病变为特点的大面积心肌梗死患者易发生心功能不全,如同时合并肾功能不全、贫血的患者死亡风险高.     

主动脉内球囊反搏在急性心肌梗死急诊PCI术后无血流现象中的应用

目的：探讨主动脉内球囊反搏（IABP）在急性心肌梗死（AMI）急诊冠脉介入术（PCI）后无复流现象（NR）中的治疗作用。方法：分析自2006年1月至2009年12月因急性心肌梗死（AMI）行PCI术后无血流患者22例资料,采用随机分组方法将其中12例运用IABP治疗,其余10例为对照组,观察术后10天内心肌损伤标志物、脑钠肽（BNP）恢复情况,心肌损伤标志物包括肌红蛋白（MYO）,肌酸激酶同工酶（CK-MB）,肌钙蛋白（ICTNI）;治疗10天后应用彩色超声心动图测量患者左房内径、左室内径、左室射血分数（LVEF）;并随访3个月、6个月左房内径、左室内径、左室射血分数（LVEF）变化情况。结果：IABP治疗组患者心肌损伤标志物指标时间-浓度曲线显示指标下降明显快于对照组,与对照组相比差别有统计学意义（P〈0.05）;IABP组BNP峰值较对照组提前,IABP治疗组BNP指标时间-浓度曲线显示指标下降明显快于对照组,与对照组相比差别无统计学意义（P〉0.05）;超声心动图测量两组患者10天、3个月及6个月时左房内径、左室内径差别及LVEF差别有统计学意义（P〈0.05）。结论：IABP能够加速降低AMI急诊PCI术后发生无复流现象患者升高心肌损伤标志物的水平;使BNP峰值提前并改善10天、3个月及6个月时左房内径、左室内径及EF值对心功能具有一定的改善作用。     

常见血清酶测定在急性心肌梗塞诊断中的应用

对1992年6月至1993年4月入院诊断为急性心肌梗塞(AMI)患者在发病后即时至48 h分三个阶段进行连续取血样测定4种血清酶（AST、CK、LDH、CKMB）的含量,且与心电图作比较.结果表明,在AMI过程中酶异常检出率最高可达到90%（AST、CK-MB）,最低为70%（LDH）.若以异常Q波为AMI确诊,其不能检出率为40%;提示在AMI早期作血清酶检测有助于进一步确诊及减少漏诊率.若AMI患者已下降的CK-MB再度上升,提示可能有新的梗死灶发生;AMI患者在发病6 h内,血清酶显著升高,提示预后不佳.     

早期心肌缺血与梗死后肌钙蛋白和肌红蛋白的观察

目的：观察早期心肌缺血（可疑）与梗死心肌细胞内肌钙蛋白（CTnT）、肌红蛋白（Mb）的变化情况.方法：应用H.E染色和免疫组织化学技术分别对6例正常心肌、11例早期心肌缺血（可疑）及9例梗死的心肌细胞内肌钙蛋白、肌红蛋白进行观察.结果：H.E染色正常组心肌未见异常;早期（可疑）心肌缺血组未见明显心肌梗死病灶;心肌梗死组见心肌梗死病灶.CTnT和Mb的免疫组织化学染色和图像分析显示,CTnT和Mb在正常组心肌的表达量明显高于早期（可疑）心肌缺血组和心肌梗死组（p＜0.05）.结论：CTnT、Mb免疫组织化学染色可用于早期（可疑）心肌缺血和心肌梗死的诊断.     

心肌坏死标志物联合检测对急性心肌梗死早期诊断及鉴别的价值

目的:探讨心肌坏死标志物联合检测在急性心肌梗死早期诊断及鉴别中的意义。方法:选取2010年12月至2013年5月我院收治的90例患者,45例确诊急性心肌梗死患者为观察组,其余45例非急性心肌梗死患者为对照组。分别采集两组患者静脉血4 m L用于检验。采用免疫抑制法测定患者血清中肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)含量,采用电化学发光法检测肌钙蛋白I(c Tn I)和肌红蛋白(MYO)含量。观察并比较不同时间点两组患者血清中CK、CK-MB、c TnⅠ及MYO含量的变化情况。结果:与对照组比较,观察组的血清CK、CK-MB、c TnⅠ及MYO的含量明显升高,其中CK及MYO升高最为显著,差异具有统计学意义(P0.05)。CK、CK-MB在发病3~6 h后快速升高,24 h达高峰;c TnⅠ前24 h与CK-MB同步,但维持时间较长;MYO在发病后1~2 h发生异常,12 h达峰值(P0.05)。结论:心肌坏死标志物联合检测可提高急性心肌梗死的检出率,有助于疾病的及时发现、诊断和治疗。     

急性心肌梗塞患者血浆肌钙蛋白T快速检测的临床价值

诊断急性心肌梗塞(AMI),心脏酶学检查具有重要的临床价值。但传统检测的各种酶学标志物存在灵敏度较低或升高持续时间较短等不足,临床上尚不能及早、准确地反映心肌缺血损伤情况。近年来,心肌特异性肌钙蛋白T(Troponin T,TnT)测定为AMI的早期诊断提供了一个敏感、特异的检查方法     

比索洛尔联合丹红注射液治疗老年心肌缺血的临床疗效

目的:探讨比索洛尔联合丹红注射液对老年心肌缺血患者血清肌钙蛋白、心肌酶水平及临床疗效的影响。方法:收集我院收治的老年心肌缺血患者58例,随机分为观察组和对照组,每组各29例。所有患者均给予调脂、抗血小板和抗心肌缺血等基础治疗。对照组患者给予丹红注射液静脉滴注,观察组在对照组基础上给予比索洛尔治疗。观察并比较两组患者治疗前后的心肌酶(CK、CK-MB、AST、LDH)、血清肌钙蛋白I(c Tn I)、肿瘤坏死因子-α(TNF-α)水平及临床疗效。结果:与治疗前相比,两组患者治疗后心肌酶(CK、CK-MB、AST、LDH)、血清肌钙蛋白I(c Tn I)及肿瘤坏死因子-α(TNF-α)水平降低(P0.05);与对照组比较,观察组患者心肌酶(CK、CK-MB、AST、LDH)、血清肌钙蛋白I(c Tn I)及肿瘤坏死因子-α(TNF-α)水平较低(P0.05),临床总有效率较高(P0.05)。结论:比索洛尔联合丹红注射液对老年心肌缺血有较好的临床疗效。     

Electrophoresis of serum isoenzymes and proteins following acute myocardial infarction

The clinical significance of the serum enzymes creatine kinase (CK, EC 2.7.3.2), lactate dehydrogenase (LD, EC 1.1.1.27) and aspartate aminotransferase (EC 2.6.1.1), and the isoenzymes CK 1–3 and LD 1–5, in acute myocardial infarction (AMI) is reviewed. Particular attention is given to electrophoretic analysis of the isoenzymes (and the CK isoforms/subforms) following AMI and thrombolytic therapy. Other protein markers for the monitoring of AMI, including myoglobin and muscle contractile proteins, are also discussed and the potential for the detection of new marker proteins using high-resolution two-dimensional electrophoretic methods is demonstrated. Whilst emphasis is placed upon electrophoretic methods the value of complementary immunoassays is acknowledged in order to maintain a balanced perspective.     

心脏晶体停搏液和冷血停搏液不同灌注方法对心肌保护的评价

目的：评估二种心脏停搏液不同灌注方法对心肌保护作用。方法：30例双瓣患者随机分为冷晶体停搏液间断灌注组(n=10),冷血停搏液间断灌注组(n=10),冷血停搏液持续灌注组(n=10),观察血浆心肌肌钙蛋白T(CnT)、肌酸激酶(CK)、肌酸激酶同工酶(CK—MB)。结果：体外循环后冷晶体停搏液间断灌注组血浆心肌肌钙蛋白T和肌酸激酶、肌酶激酶同工酶较其他2组明显增高;冷血停搏液间断灌注组和冷血停搏液持续灌注组血浆心肌肌钙蛋白T、肌酸激酶、肌酸激酶同工酶无明显差异。结论：冷血停搏液的心肌保护优于冷晶体停搏液,冷血停搏液间断灌注与持续灌注没有明显差异。     

Chest pain with nondiagnostic electrocardiogram in the emergency department: a randomized controlled trial of two cardiac marker regimens

BACKGROUND: Early detection of acute myocardial infarction (AMI) may save lives. In the emergency setting, it is unclear whether the early use of certain cardiac markers (myoglobin and cardiac troponin I [cTnI]) assists in making appropriate decisions whether to admit or discharge patients with chest pain of possible ischemic cause who have nondiagnostic electrocardiograms (ECGs). We performed a study to determine whether the addition of new cardiac markers in the emergency department results in improved clinical decisions. METHODS: A single-blind randomized controlled trial was conducted between June 1997 and June 1998 in a tertiary care emergency department in Kingston, Ont. Of 296 patients aged 30 years or more who presented to the emergency department with chest pain and nondiagnostic ECGs, 146 were randomly assigned to the intervention group (determination of baseline creatine kinase [CK] level, CK MB fraction and cTnI level, and myoglobin level at baseline and at 2 hours) and 150 to the control group (determination of baseline CK level and CK MB fraction). Outcome measures included the rate of admission to the inpatient cardiology service and length of stay in the emergency department. RESULTS: Of the 296 patients, 34 (11.5%) received a diagnosis of AMI in the emergency department, and 92 (31.1%) had chest pain of noncardiac cause. Patients in the intervention group were less likely than those in the control group to be admitted to the cardiology service (67 [45.9%] v. 81 [54.0%]). The absolute difference in the proportion (8.1% [95% confidence interval -3.3 to 19.5]), although potentially important clinically, was not statistically significant. The length of stay in the emergency department was essentially the same in the 2 study groups. At 30 days, the proportions of patients with a diagnosis of recurrent angina (58.2% in the intervention group and 58.0% in the control group) and AMI (12.3% and 14.7%) were also similar. INTERPRETATION: The optimal cardiac marker panel to be used in the emergency department remains unknown. The addition of serial testing of myoglobin with cTnI confirmation to the standard panel did not substantially change the clinical management or outcomes of patients presenting with chest pain and nondiagnostic ECGs.     

Development of optical biosensor technologies for cardiac troponin recognition

Acute myocardial infarction (AMI) is the leading cause of death among cardiovascular diseases. Among the numerous attempts to develop coronary marker concepts into clinical strategies, cardiac troponin is known as a specific marker for coronary events. The cardiac troponin concentration level in blood has been shown to rise rapidly for 4–10 days after onset of AMI, making it an attractive approach for a long diagnosis window for detection. The extremely low clinical sensing range of cardiac troponin levels consequently makes the methods of detection highly sensitive. In this review, by taking into consideration optical methods applied for cardiac troponin detection, we discuss the most commonly used methods of optical immunosensing and provide an overview of the various diagnostic cardiac troponin immunosensors that have been employed for determination of cardiac troponin over the last several years.     

心肌型脂肪酸结合蛋白胶体金检测试纸条的制备和初步应用

目的应用胶体金免疫层析法制备检测全血或血清样本中心肌型脂肪酸结合蛋白（H-FABP）的检测试纸条,用于急性心肌梗塞（AMI）的早期辅助诊断。方法采用柠檬酸三钠还原法制备胶体金,标记鼠抗心肌型脂肪酸结合蛋白单克隆抗体,喷于玻璃纤维膜上制成胶体金结合物垫,将另一株鼠抗心肌型脂肪酸结合蛋白单克隆抗体和抗鼠二抗分别包被检测线和质控线,组装成试纸条进行灵敏性、特异性、精密性、稳定性及临床样品检测。结果该试纸条的检测灵敏度为10ng／mL,15min内可判定结果;与肌钙蛋白I、C反应蛋白、肌酸激酶、人心肌肌红蛋白无交叉反应。检测240份临床标本,与临床诊断结果进行配对分析,阳性符合率95．83％、阴性符合率100％、总符合率97．92％。结论制备的H-FABP检测试纸条有良好的灵敏性、特异性,可用于早期AMI的辅助诊断。     

New,simple and cheap alternative to troponin test for diagnosis of acute myocardial infarction

Acute myocardial infarction (AMI) is often a fatal disorder in humans seen throughout the world. It was earlier diagnosed with some serum enzymes like aspartate transaminase, creatine phosphokinase and its isoenzyme CPK-MB and lactate dehydrogenase which were shown to be increased in AMI. However, in the last few years importance has been given to measuring serum troponins released from the injured myocardium to confirm an AMI. Troponin estimation involves immunological technique, which is expensive with other associated problems like shelf life of reagents, number of samples to be analysed and availability of the kit itself, used for estimation. Under these circumstances the present work involves the measurement of total salt soluble proteins which are proteins associated with troponins also released from myocardium of a patient with AMI. This new test overrules all the disadvantages of the troponin test but seems equally viable and useful for diagnosis of AMI.     

血清CREG蛋白在急性心肌梗死早期的表达研究

目的：探讨血清中CREG蛋白在急性心肌梗死发作早期的表达情况,尝试为临床心肌缺血的极早期诊断提供一种新的血清标志分子。方法：在2010年6月至2010年11月期间,入选在沈阳军区总医院心内科住院治疗的急性ST段抬高型心肌梗死患者50例及非AMI对照50例,于AMI组胸痛发作后的不同时间点采血测定CK、CK—MB、LDH和cTnT,同时应用Westem blot技术测定血清中CREG蛋白的含量,并与对照组比较。结果：AMI组发病72小时内的血清中CREG蛋白表达均较对照组有不同程度的增高（P〈0．05）。胸痛开始2h内,AMI组血清中CREG的含量即明显增高,其在2h、4h及6h的含量显著高于对照组（P〈0．001）。在胸痛已经发作2小时内,两组间血清cTnT、CK、CK-MB及LDH水平比较无统计学意义（P〉0．05）。结论：CREG在AMI患者血清中的表达增高．其在血清中表达时间早于cTNT及CK-MB。     

Effects of blood sample anticoagulants on lateral flow assays using luminescent photon-upconverting and Eu(III) nanoparticle reporters

Many quantitative and semiquantitative lateral flow (LF) assays have been introduced for clinical analytes such as biomarkers for cancer or acute myocardial infarction (AMI). Various detection technologies involving quantitative analyzing devices have been reported to have sufficient analytical sensitivity and quantification capability for clinical point-of-care tests. Fluorescence-based detection technologies such as quantum dots, Eu(III) nanoparticles, and photon-upconverting nanoparticles (UCNPs) have been introduced as promising solutions for point-of-care devices because of their high detectability by optical sensors. Lateral flow assays can be used for various sample types, e.g., urine, saliva, cerebrospinal fluid, and blood. This study focuses on the properties of serum and plasma because of their relevance in cancer and AMI diagnostics. The limit of detection was compared in LF assays having Eu(III) nanoparticles or UCNPs as reporters and the antibody configurations for two different analytes (prostate-specific antigen and cardiac troponin I (cTnI)). The results indicate a significant effect of anticoagulants in venipuncture tubes. The samples in K₃EDTA tubes resulted in significant interference by decreased reporter particle mobility, and thus the limit of detection was up to eightfold less sensitive compared to serum samples. Despite the matrix interference in the cTnI assay with UCNP reporters, limits of detection of 41 ng/L with serum and 66 ng/L with the Li-heparin sample were obtained.