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目的 :通过观察血清肌钙蛋白I(cTnI)和肌酸激酶 同工酶 (CK MB)的变化 ,了解经皮腔内冠状动脉成形术 (PTCA)和支架术后心肌微损伤情况及其对近期预后的影响。方法 :选择 83例经造影证实为单支血管病变的稳定型心绞痛行PTCA和支架术后无严重并发症者。测定术前 ,术后 6、12、2 4及 4 8h血清cTnI、CK MB的水平 ,并随访观察术后 4～ 5周内心血管事件的发生情况 ,以及通过超声心动图检查术前和术后随访期间左室射血分数的变化。结果 :术后 2 3例出现cTnI或 (和 )CK MB阳性者 ,其中支架组 2 1例 ,球囊组 2例。cTnI阳性检出率 (2 4 .1% )明显高于CK MB阳性检出率 (6 .0 % ) (P <0 .0 1)。cTnI和 (或 )CK MB阳性 (损伤组 )术中球囊扩张的总时间、单次扩张最长时间以及分支血管阻塞的发生率均明显高于cTnI和 (或 )CK MB阴性 (未损伤组 ) (分别为P <0 .0 5、P <0 .0 1、P <0 .0 1) ,而球囊扩张次数和扩张的最大压力两组相比无明显差别 (P >0 .0 5 ) ,随访术后近期心血管事件的发生率和左室功能的变化两组无明显差异。结论 :PTCA及支架术后心肌微损伤并不少见 ,尤以支架术后发生率高。这种微损伤对近期预后的影响不大。检测这种微损伤的指标以cTnI明显优于CK MB。
OBJECTIVE: To investigate the changes of myocardial cTnI and CK MB in patients with percutaneous transluminal coronary angioplasty (PTCA) The impact of prognosis. Methods: Totally 83 patients with stable angina pectoris confirmed by angiography were treated with PTCA and no major complication after stenting. The serum levels of cTnI and CK MB were measured before and 6, 12, 24 and 48 h after operation, and the incidence of cardiovascular events within 4 to 5 weeks after operation was observed and followed up by echocardiography Changes of left ventricular ejection fraction during follow - up. Results: Twenty-three cases had positive cTnI or (and) CK-MB after operation, including 21 cases in stent group and 2 cases in balloon group. The positive detection rate of cTnI (24.1%) was significantly higher than that of CK MB (6.0%) (P <0.01). The total duration of balloon dilatation, the longest single dilation, and the incidence of branch vessel occlusion in cTnI and / or CK MB positive (injury group) surgery were significantly higher than those in cTnI and / or CK MB negative (uninjured group ) (P <0.05, P <0.01, P <0.01), while there was no significant difference between the number of balloon dilation and the maximum dilation pressure (P> 0.05) ), The incidence of recent cardiovascular events and changes in left ventricular function after follow-up no significant difference between the two groups. Conclusion: Myocardial micro-damage after PTCA and stenting is not uncommon, especially after stenting. This micro-injury has little effect on the recent prognosis. The index of detecting this micro-injury was significantly superior to CK MB with cTnI.