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首页> 美国卫生研究院文献>Indian Journal of Clinical Biochemistry >Evaluation of clinical utility of serum enzymes and troponin—T in the early stages of acute myocardial infarction
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Evaluation of clinical utility of serum enzymes and troponin—T in the early stages of acute myocardial infarction

机译：急性心肌梗死早期血清酶和肌钙蛋白-T的临床应用价值评估

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Laboratory infarction diagnostics are based on the detection of elevated serum activities of total Creatine Kinase (CK), Creatine Kinase isoensyme MB, (CKMB), Lactate dehydrogenase (LDH), isoenzyme forms of LDH and transaminases. Determination of these cardiac marker enzymes permits a highly sensitive diagnosis of transmural myocardial infarction. In such patients the diagnosis of acute myocardial infarction can be confirmed by the clinical, symptoms, and changes in the ECG in addition to the enzyme assays. The 50 AMI patients selected in the present study were those admitted to the ICCU of Shri Krishna Hospital, Karamsad. The blood samples were taken at the time of admission (ie. within four hours of the start of chest pain). The samples were analyzed for CK, CKMB, SGOT, (Serum glutamate oxaloactate transaminase) αHBDH α-hydroxybutyrate dehydrogenase and troponin T. The serum CKMB activity in AMI showed an increase only 5–6 hours after the commencement of chest pain. The elevation in SGOT and αHBDH was still delayed. At the same time we could observe that the cardiac Troponin T (cTnT) was elevated at the time of admission of the patient itself. This increase of cTnT in AMI patients was 20 times higher than the normal blood donors. The controls included 25 normal blood donors and 25 patients with polytraumatic injuries with no chest contusion. The study shows that cTnT estimation could serve in the early diagnosis of AMI. The increase of cardiac troponin T in AMI patients was 20 times higher than the normal blood donors in AMI patients at the time of admission. Cardiac troponin T in serum appears to be a more sensitive indicator of myocardial cell injury than CKMB activity and its detection in the circulation may be a useful prognostic indicator in patients with unstable angina as well. When the blood of normal blood donors or that of patients with polytraumatic injury was analysed the troponin T values were well within the normal range in both the above categories showing that cardiac troponin T is highly specific for heart tissue. Although CKMB and cardiac troponin T are released soon after the myocardial injury, the release of cardiac troponin T is much earlier than CKMB thereby invalidating the important role of cardiac troponin T in diagnosing AMI. Cardiac troponin T has been shown to be highly sensitive for cardiac injury and not elevated in any other trauma, heavy exercise or skeletal muscle injury. Cardiac troponin T is ordinarily undetectable in healthy individuals, and so its measurement can serve as a powerful tool in the diagnosis of AMI.
机译：实验室梗死诊断基于对总肌酸激酶（CK），肌酸激酶同工酶MB（CKMB），乳酸脱氢酶（LDH），LDH和转氨酶同工酶水平升高的血清活性的检测。这些心脏标记酶的测定可以高度灵敏地诊断壁间心肌梗塞。在此类患者中，除了酶测定法外，还可通过临床，症状和ECG的变化来确诊急性心肌梗死。在本研究中选择的50例AMI患者是Karamsad的Shri Krishna Hospital的ICCU入院的患者。在入院时（即在胸痛开始后的四个小时内）采集血样。分析了样本中的CK，CKMB，SGOT（血清谷氨酸草酸酯转氨酶）αHBDHα-羟基丁酸脱氢酶和肌钙蛋白T。AMI的血清CKMB活性仅在开始出现胸痛后5-6小时才增加。 SGOT和αHBDH的升高仍被延迟。同时，我们可以观察到患者入院时心脏肌钙蛋白T（cTnT）升高。 AMI患者中cTnT的增加是正常献血者的20倍。对照组包括25名正常献血者和25例多发性创伤且无胸部挫伤的患者。研究表明，cTnT估计可用于AMI的早期诊断。入院时，AMI患者的心肌肌钙蛋白T升高是正常献血者的20倍。血清肌钙蛋白T似乎比CKMB活性更敏感，是心肌细胞损伤的指标，在​​不稳定型心绞痛患者中，其循环中的检测也可能是有用的预后指标。当分析正常献血者的血液或多创伤性损伤患者的血液时，上述两个类别中的肌钙蛋白T值均在正常范围内，表明心脏肌钙蛋白T对心脏组织具有高度特异性。尽管CKMB和心肌肌钙蛋白T在心肌损伤后很快释放，但心肌肌钙蛋白T的释放比CKMB早得多，从而使心肌肌钙蛋白T在诊断AMI中的重要作用无效。心肌肌钙蛋白T已显示对心脏损伤高度敏感，在任何其他创伤，剧烈运动或骨骼肌损伤中均未升高。在健康个体中通常无法检测到心肌肌钙蛋白T，因此其测量值可作为AMI诊断的有力工具。

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