肌酸激酶同工酶在室间隔缺损介入治疗中的意义
摘要
目的探讨肌酸激酶同工酶(CK-MB)在先天性心脏病(CHD)室间隔缺损(VSD)介入治疗中的临床价值。方法选择临沂市人民医院儿内科二病区2017年3-12月住院接受介入封堵治疗的VSD患儿50例,缺损范围3～10mm。分别在术前及术后6h、24h、3d、5d抽取静脉血测定心肌肌钙蛋白T(cTnT)及CKMB水平。结果患儿术前cTnT及CK-MB均处于正常范围,二者数值高峰均出现于术后6h,CK-MB、cTnT分别于术后24h、5d恢复正常;CK-MB、cTnT水平在术后6h呈正相关,患儿不同时间点血清CK-MB、cTnT水平比较差异均有统计学意义(P<0.05)。结论 VSD介入封堵治疗可引起血清cTnT及CK-MB水平升高并引起心肌可逆性微损伤;在评估介入治疗造成的心肌损伤中,单纯CK-MB水平的小范围变化并不能做出确切诊断。
引文
[1]杨贵明,刘凤.心肌肌钙蛋白与先天性心脏病介入损伤的研究进展[J].国际儿科学杂志,2011,38(1):44-46.
[2]STEPHENSON E A,BERUL C I.Electrophysiological interventions for inherited arrhythmia syndromes[J].Circulation,2007,116(9):1062-1080.
[3]高磊,刘君,田骆冰,等.介入治疗前后室间隔缺损患儿血清心肌肌钙蛋白I水平的变化[J].实用儿科临床杂志,2012,27(1):38-40.
[4]DEFILIPPI C R,CHRISTENSON R H,GOTTDIENER JS,et al.Dynamic cardiovascular risk assessment in elderly Pepole.The role of repeated N-terminal pro-B-type natriuretic peptide testing[J].J Am coll cardiol,2010,55(5)441-450.
[5]TANG W H,FRANCIS G S,MORROW D A,et al.National academy of clinical biochemistry laboratort medicine practice guide lines:clinical utilization of cardiac biomaker testing in heart failure[J].Clin Biochem,2013,41(5):22-25.
[6]JEREMIAS A,GIBSON M.Narrative review:alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded[J].Ann Intern Med,2005,142(9):786-791.
[7]KORFF S,KATUS H A,GIANNITSIS E.Differential diagnosis of elevated troponins[J].Heart,2006,92(7):987-993.
[8]BRUCATO A,PREVITALI E,RAMONI V,et al.Arrhythmias presenting in neonatal Iupus[J].Scand J Immunol,2010,72(3):198-204.
[9]高东升,张善同,孙晓斐.肌酸激酶、肌酸激酶同工酶、心肌肌钙蛋白T对射频消融所致心肌损伤检测的比较[J].临床心血管杂志,2000,16(5):199-202.
[10]MAYBARD S J,MENOWN I B,ADGEY A A.Troponin T or I as cardiac markers in ischaenic heart disease[J].Heart,2000,83(4):371-373.
[11]OKMEN E,KASIKCIOGLU H,SANLI A,et al.Correlations between cardiac troponin I,cardiac troponin T,and creatine phosphokinase MB elevation following successful percutaneous coronary intervention and prognostic value of each marker[J].Invasive Cardiol,2005,17(2):63-67.
[12]张智慧,赵会海.血清单项CK-MB增高的临床分析[J].中国误诊学杂志,2007,7(22):5281-5282.
[13]中国询证心血管医学杂志.CK-MB增高≠心肌损伤:说说心肌酶学那些事儿[J].中国询证心血管医学杂志,2016,8(5):546.
[14]梁海琦.肌钙蛋白I和肌酸激酶同工酶定量检测对急性心肌梗死的诊断价值[J].临床合理用药杂志,2017,10(30):128-129.
[15]肖建平.超敏肌钙蛋白T和肌酸激酶同工酶联合检测在诊断小儿心肌炎方面的价值分析[J].当代医药论丛,2014,12(2):169.
[16]于晓,盛尚春,张新悦,等.联合检测超敏肌钙蛋白T和肌酸激酶同工酶在小儿心肌炎诊断中的应用[J].国际检验医学杂志,2012,33(23):2873-2874.
[2]STEPHENSON E A,BERUL C I.Electrophysiological interventions for inherited arrhythmia syndromes[J].Circulation,2007,116(9):1062-1080.
[3]高磊,刘君,田骆冰,等.介入治疗前后室间隔缺损患儿血清心肌肌钙蛋白I水平的变化[J].实用儿科临床杂志,2012,27(1):38-40.
[4]DEFILIPPI C R,CHRISTENSON R H,GOTTDIENER JS,et al.Dynamic cardiovascular risk assessment in elderly Pepole.The role of repeated N-terminal pro-B-type natriuretic peptide testing[J].J Am coll cardiol,2010,55(5)441-450.
[5]TANG W H,FRANCIS G S,MORROW D A,et al.National academy of clinical biochemistry laboratort medicine practice guide lines:clinical utilization of cardiac biomaker testing in heart failure[J].Clin Biochem,2013,41(5):22-25.
[6]JEREMIAS A,GIBSON M.Narrative review:alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded[J].Ann Intern Med,2005,142(9):786-791.
[7]KORFF S,KATUS H A,GIANNITSIS E.Differential diagnosis of elevated troponins[J].Heart,2006,92(7):987-993.
[8]BRUCATO A,PREVITALI E,RAMONI V,et al.Arrhythmias presenting in neonatal Iupus[J].Scand J Immunol,2010,72(3):198-204.
[9]高东升,张善同,孙晓斐.肌酸激酶、肌酸激酶同工酶、心肌肌钙蛋白T对射频消融所致心肌损伤检测的比较[J].临床心血管杂志,2000,16(5):199-202.
[10]MAYBARD S J,MENOWN I B,ADGEY A A.Troponin T or I as cardiac markers in ischaenic heart disease[J].Heart,2000,83(4):371-373.
[11]OKMEN E,KASIKCIOGLU H,SANLI A,et al.Correlations between cardiac troponin I,cardiac troponin T,and creatine phosphokinase MB elevation following successful percutaneous coronary intervention and prognostic value of each marker[J].Invasive Cardiol,2005,17(2):63-67.
[12]张智慧,赵会海.血清单项CK-MB增高的临床分析[J].中国误诊学杂志,2007,7(22):5281-5282.
[13]中国询证心血管医学杂志.CK-MB增高≠心肌损伤:说说心肌酶学那些事儿[J].中国询证心血管医学杂志,2016,8(5):546.
[14]梁海琦.肌钙蛋白I和肌酸激酶同工酶定量检测对急性心肌梗死的诊断价值[J].临床合理用药杂志,2017,10(30):128-129.
[15]肖建平.超敏肌钙蛋白T和肌酸激酶同工酶联合检测在诊断小儿心肌炎方面的价值分析[J].当代医药论丛,2014,12(2):169.
[16]于晓,盛尚春,张新悦,等.联合检测超敏肌钙蛋白T和肌酸激酶同工酶在小儿心肌炎诊断中的应用[J].国际检验医学杂志,2012,33(23):2873-2874.