摘要
目的 评价心肌肌钙蛋白T(cTnT)、心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶 (CK MB)在诊断心肌损伤中的灵敏度和特异性 ;了解射频消融 (RFCA)心肌损伤程度与消融因素的相关性。方法 于术前、术后 30min、4h、12h、2 4h测量 39例接受RFCA治疗者的血清cTnT和cTnI浓度及CK MB活性。对照组 (n =10 )仅接受电生理检查 (EPS)。结果 39例患者均无并发症出现。cTnT基础值为 (0 0 1± 0 0 0 4)ng ml,术后 30min为 (0 2 7± 0 13)ng ml(P <0 0 5 ) ,4h达高峰水平 [(0 2 9±0 12 )ng ml,P <0 0 5 ]。cTnI基础值 (0 34± 0 2 2 )ng ml,术后 30min为 (1 6 7± 1 10 )ng ml(P <0 0 5 ) ,4h达高峰水平 [(1 72± 1 5 0 )ng ml,P <0 0 5 ]。CK MB术前、术后无显著差异。 39例患者中 2 9例(74% )cTnT≥ 0 1ng ml(P <0 0 5 ) ,2 2例 (5 6 % )cTnI≥ 1 0ng ml(P <0 0 5 ) ,两者无显著差异。cTnT峰值水平与消融靶点数、消融总时间、消融总次数、累积能量具有相关性 ;心室放电组cTnT水平明显高于心房放电组 (P <0 0 5 )。结论 cTnT和cTnI诊断心肌损伤的灵敏度和特异性相似 ,且优于CK MB ;RFCA中应力求准确定位、减少试探性放电、缩短放电时间、降低放电功率 ,以最大限度地减少心肌损伤。
Objective To estimate the sensitivity and specificity of cTnT, cTnI and CK MB in detecting myocardial damage, and to investigate the degree of myocardial injury incurred by RFCA Methods In 39 patients undergoing RFCA for a variety of arrhythmias, cTnT, cTnI and CK MB levels were measured before, and 30 min, 4 h, 12 h, 24 h after RFCA These biochemical markers were also measured in 10 patients (control group) having only EPS without RFCA Results There were uncomplicated in 39 patients Baseline cTnT levels averaged (0 01±0 004)ng/ml, rose to (0 27±0 13)ng/ml at 30 min after RFCA ( P <0 05) cTnT peak levels were [(0 29±0 12)ng/ml, P <0 05] and most were measured at the 4h samples Baseline cTnI levels averaged (0 34±0 12)ng/ml, rose to (1 67±1 10)ng/ml at 30 min ( P <0 05) cTnI peak levels were [(1 72±1 50)ng/ml, P <0 05] and most were measured at the 4 h samples, too There were no significant diffrences between the levels of CK MB pre ablation samples and post ablation samples cTnT levels were increased (≥0 1 ng/ml) in 29 patients (74%) ( P <0 05), and cTnI levels were increased (≥1 0 ng/ml) in 22 patients (56%) ( P <0 05), while there were no significant diffrences between them cTnT peak levels correlated with radiofrequency ablation sites,total time of radiofrequency application, the number of radio frequency pulses and the accumulative power released in RFCA The cTnT levels of the group ablated in ventricle were significantly higher than that of the group ablated in atrium ( P <0 05) Conclusion The sensitivity and specificity of cTnT, cTnI are similar to detect myocardial damage, and better than CK MB To limit myocardial lesion in patients who undergo the precedure, it is very important to precisely locate ablated position to reduce radiofrequency ablation sites, to shorten time of radio frequency appliation and to decrease power used
出处
《中国介入心脏病学杂志》
2002年第3期123-126,共4页
Chinese Journal of Interventional Cardiology
