急性ST段抬高性心肌梗死患者再灌注治疗后心肌损伤指标动态变化的价值

摘要

目的：探讨急性心肌梗死（AMI）患者血浆中的心肌标志物、高敏C反应蛋白（hs-CRP）、纤维蛋白原（Fib）及D-二聚体（D-D）水平的动态变化及其临床意义。方法选取2012年4月～2014年6月于广安市人民医院心内科住院发病在12 h内的ST段抬高型心肌梗死（STEMI）患者98例，分别检测再灌注前、治疗后2h、6h、12 h、24 h、36 h、48 h、3d、4 d直至第7 d血浆中的肌红蛋白（MYO）、肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）、hs-CRP、Fib及D-D的水平变化。结果 MYO出现时间早，12~24 h达峰值，36 h后基本恢复正常；CK-MB16~24 h达峰值；cTnI维持时间长，18~24 h达峰值；hs-CRP浓度逐渐下降；D-D在溶栓治疗6 h后达峰值；Fib经治疗后降低缓慢。结论 STEMI患者MYO和cTnI的测定对早期诊断有重要意义；hs-CRP是对心肌损伤的判断有一定价值；D-D对治疗效果的监测也有一定意义。%Objective To discuss dynamic changes and clinical value of myocardial markers, hypersensitive c-reactive protein, fibrinogen and D dimer levels in patients with acute myocardial infarction (AMI).Methods 98 patients of West China-Guang'an Hospital from April 2012-June 2014 with ST-segment-elevation myocardial infarction (STEMI) who present within 12 hours of onset were selected. Myoglobin (MYO), troponin I (cTnI), creatine kinase isoenzyme (CK-MB), high-sensitivity C-reactive protein (hs-CRP), fibrinogen (Fib) and D- dimer (DD) were measured before and after treatment for 2 hours, 6 hours, 12 hours, 24 hours, 36 hours, 48 hours, 3 days, 4 days and 7 days.Results MYO level peaked during 12 to 24 hours after treatment, and went back to normal after 36 hours. CK-MB level peaked during 16-24 hours after treatment. cTnI level peaked during 18 to 24 hours after treatment. Level of hs-CRP dropped gradually. DD level peaked at 6 hours after treatment. Fib dropped slowly after treatment. Conclusion MYO and cTnI of STEMI patients are valuable for early diagnosis. Hs-CRP has certain value for diagnosis of myocardial injury. DD has certain value for surveillance of treatment effect.