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目的 适时合理选择急性心肌梗死 (AMI)溶栓疗效判断中血清酶学指标。方法 回顾性分析 145例AMI溶栓患者血清酶学及心肌肌钙蛋白T(TnT)资料 ,其中男 10 7例 ,女 38例 ,平均年龄 (6 1 9± 9 3)岁。以无创指标判断溶栓成功者 110例 ,未成功者 35例。 6 5例行冠脉造影 ,梗死相关血管 (IRA)开通者 44例 ,未开通者2 1例。 5 9例同时测定TnT。结果 (1)TnT首次异常检出率 84 7% ,高于肌酸磷酸激酶 (CK)同功酶 (CK -MB)(4 9 2 % ) (P <0 0 5 )。 (2 )溶栓成功、IRA开通者与溶栓未成功、IRA未开通者间CK/CK -MB峰值无显著性差异 (P >0 0 5 )。结论 (1)TnT用于AMI心肌损伤早期诊断优于CK -MB。 (2 )CK/CK -MB峰值前移与溶栓成功与否、IRA开通与否有关 ,而CK/CK -MB峰绝对值与此无直接关系。对早期溶栓的AMI患者不必过早取血测定CK/CK -MB ,而在发病后 16～ 2 0h间取血测定即可满足判断酶峰是否前移的需要 ,从而减轻病人痛苦和经济负担。
Objective To select the serum enzymological indexes in thrombolytic therapy of acute myocardial infarction (AMI) timely and reasonably. Methods A retrospective analysis of 145 patients with AMI thrombolysis serum enzyme and cardiac troponin T (TnT) data, including 107 males and 38 females, the average age (6 1 9 ± 9 3) years old. Noninvasive indicators to determine the success of thrombolysis in 110 cases, 35 cases of unsuccessful. Sixty-five routine coronary angiography, infarct-related blood vessels (IRA) opened in 44 cases, not open 21 cases. 59 cases of simultaneous determination of TnT. Results (1) The first detection rate of TnT was 84.7%, higher than that of CK-MB (49.2%) (P <0.05). (2) The success of thrombolysis, no significant difference between the peak of CK / CK-MB in IRA preoperation and those without IRA preoperation and thrombolysis (P> 0.05). Conclusions (1) TnT is superior to CK-MB in the early diagnosis of AMI myocardial injury. (2) CK / CK-MB peak forward and thrombolysis success or not, IRA open or not, while the absolute value of CK / CK-MB peak is not directly related to this. It is not necessary to take CK / CK-MB for premature thrombolysis in AMI patients, but to determine whether the peak of the enzyme is advancing before the blood sample is taken between 16 and 20 h after the onset of disease, thus alleviating patient’s pain and financial burden .