Correlation among troponin, ck-mb and acute myocardial infarction range in aged patients deng jin-qing1, liu ze2, guo zhen-hui3, zhou wei-liang4 General Hospital of Guangzhou Military Command( Overseas Division;




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心血管康复医学杂志2014年8月第23卷第4期 Chin J Cardiovasc Rehab Med,August 2014,Vol 23 No.4




Correlation among troponin, CK-MB and acute myocardial infarction range in aged patients
DENG Jin-qing1, LIU Ze2, GUO Zhen-hui3, ZHOU Wei-liang4

General Hospital of Guangzhou Military Command1. Overseas Division; 2. Department of Geriatrics; 3. Medical Intensive Care Unit; 4. Department of Emergency, Guangzhou, Guangdong, 510010, China
Abstract: Objective: To explore the correlation among cardiac troponin I (cTnI), cardiac troponin T (cTnT), creatine kinase isoenzyme (CK-MB) levels and range of myocardial infarction in aged patients with acute myocardial infarction (AMI). Methods: Clinical data of 80 aged AMI patients hospitalized in our internal medicine department from Sep 2012 to Sep 2013 were retrospectively analyzed. Correlation among levels of cTnI, cTnT, CK-MB and range of myocardial infarction were analyzed before and one week after treatment. Results: Compared with before treatment, there were significant reductions in levels of cTnI [(4.63±0.21) μg/L vs. (0.15±0.03) μg/L], cTnT[(0.71±0.05) μg/L vs. (0.17±0.01) μg/L], CK-MB [(40.21±2.13) U/L vs. (23.32±2.11) U/L] and myocardial infarction area [(35.25±4.65) mm2 vs. (23.17±3.76)mm2] after treatment, P<0.01 all; Pearson correlation analysis indicated that cTnI, cTnT and CK-MB were all positively correlated with myocardial infarction area (r=0.99, 0.98, 0.95, P<0.01 all). Conclusions: Cardiac troponin I, T and creatine kinase isoenzyme are closely related to myocardial infarction range. Combination of these three indexes can be used as important basis for judging myocardial infarction range in patients with myocardial infarction.

Key word: Myocardial infarction; Troponin; The aged

Article number 1008-0074(2014)04-375-04

Doi: 10.3969/j. issn. 1008-0074. 2014.04.04
肌钙蛋白及肌酸激酶同工酶与老年急性心肌梗死范围的相关性/邓锦清, 刘泽 , 郭振辉, 周伟良//广州军区广州总医院(1. 华侨科: 邓锦清, 2. 老年病科: 刘泽:,3. MICU科: 郭振辉,4.急诊科: 周伟良),广东 广州 510010
摘要:目的:探讨心肌肌钙蛋白I(cTnI)、、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)的变化范围和老年心肌梗死(AMI)患者心肌梗死范围的相关性。方法:回顾性分析2012年9月至2013年9月于我院内科住院的80例老年心肌梗死患者的临床资料,分析治疗前和治疗一周后cTnI、cTnT、CK-MB值与心肌梗死范围的相关性。结果:与治疗前比较,治疗后患者cTnI[(4.63±0.21) μg/L比(0.15±0.03) μg/L]、cTnT[(0.71±0.05) μg/L比(0.17±0.01) μg/L]、CK-MB[(40.21±2.13) U/L比(23.32±2.11) U/L]水平显著下降,心肌梗死面积[(35.25±4.65) mm2比(23.17±3.76)mm2]显著减小(P均<0.01);Pearson相关分析显示,cTnI、cTnT及CK-MB与心肌梗死面积均呈显著正相关(r=0.99、0.98、0.95,P均<0.01)。结论:肌钙蛋白I、心肌肌钙蛋白T、肌酸激酶同工酶与心肌梗死范围关系密切,这三个指标值的结合可作为判断老年心肌梗死患者心肌梗死范围的重要依据。

关键词: 心肌梗塞;肌钙蛋白;老年人

文章编号:1008-0074(2014)04-375-04 中图分类号:R542.2209 文献标识码:A

Doi: 10.3969/j. issn. 1008-0074. 2014.04.04


Acute myocardial infarction (AMI) is partial acute myocardial necrosis caused by acute, severe and sustained coronary artery myocardial ischemia and hypoxia. Along with age increases, the morbidity has a tendency to rise gradually. Patients usually present as intensive and sustained retrosternal pain, and elevated serum myocardial enzyme activity etc., they can also complicate with arrhythmia, shock or heart failure; their attack is abrupt; and its mortality is higher. Therefore, early judgment of myocardial infarction is very important, which is of important significance to stop enlargement of infarct area, cure myocardial infarction [1-2]. Now cardiac troponin I (cTnI), cardiac troponin T (cTnT) and creatine kinase isoenzyme (CK-MB) are usually used to judge cardiac damage [3-4]. We made a retrospective analysis on data of aged AMI patients hospitalized from Sep 2012 to Sep 2013, explored the role of cTnI, cTnT and CK-MB in diagnosing AMI range in aged patients. They were reported as follow.
1. Data and methods

1.1 General data

Myocardial infarction was diagnosed according to diagnostic standard of World Health Organization (WHO): 1. Chest pain occurs and lasts for ≥30min, not apparent relief after taking nitroglycerin; 2. ST segment elevates >1mm on at least two limb leads or adjacent precordial leads in ECG; 3. Cardiac CK-MB or cTnI is two times higher than the normal value. Based on above standards, a total of 80 aged AMI patients, who hospitalized in our department of internal medicine from Sep 2012 to Sep 2013, were regarded as subjects. There were 48 males and 32 females with age 60~78(67.12±3.13) years old, including 18 cases of anteroseptal wall, 25 cases of inferior wall, 23 cases of extensive anterior wall and 24 cases of upper sidewall AMI. After ECG examination, all patients were excluded for ventricular hypertrophy and bundle branch block. No patient had old heart diseases or received relative treatment. Before collecting blood sample, patients were forbidden to drink wine.

The present study has been approved by medical morality committee; all participants signed informed consent and ensured participating in this research were voluntary.
1.2 Methods

1.2.1 Research methods: All AMI patients received emergency percutaneous coronary intervention (PCI). They received measurement of cTnI, cTnT, CK-MB and myocardial infarction area before and one week after treatment.

1.2.2 Measurements of cTnI, cTnT and CK-MB: The 4 ml ulnar vein blood was collected, centrifuged to obtain serum for detection. Olympus AU5400 automatic biochemical analyzer was used to measure cTnI, cTnT and CK-MB. Fluorescent dry quantitative analyzer for myocardial infarction was used to measure myocardial infarction range. In general, its normal ranges are cTnI<0.2μg/L, cTnT<0.1μg/L, CK-MB<25U/L. When cTnI>1.5μg/L, cTnT>0.5μg/L, CK-MB > 25U/L, it was abnormal.

1.2.3 Calculation of myocardial infarction range: Myocardial infarction size (IS) was assessed according to QRS scoring system suggested by Nancy B Hindman (54 standards and 32-score system). When QRS score rise by 1 score, it suggested that left ventricle increase 3% infarct area. Myocardial infarction size was calculated in patients before treatment and one week after hospitalization respectively.


1.3 Statistical method

SPSS 17.0 software was used to perform statistical analysis. Measurement data were expressed as mean ± standard deviation (), and its comparison was performed using t test. Numeration data were expressed as percentage, and its comparison was performed using chi-square test. Pearson correlation analysis was used to analyze the correlation among three myocardial enzymes and infarct area. P<0.05 was regarded as possessing significant difference.


2. Results

2.1 Comparison of myocardial enzyme concentrations and infarct area between before and after treatment

Compared with before treatment, there were significant reductions in levels of cTnI, cTnT and CK-MB, infarct area after one-week treatment, P<0.05 all. They were shown in table 1.



Table 1 Comparison of myocardial enzymes and myocardial infarct area between before


and after treatment




Before treatment

One week after treatment

t

P

cTnI (μg/L)

4.63±0.21

0.15±0.03**

81.79

0.001

cTnT (μg/L)

0.71±0.05

0.17±0.01**

19.72

0.001

CK-MB (U/L)

40.21±2.13

23.32±2.11**

73.37

0.001

Infarct area (mm2)

35.25±4.65

23.17±3.76**

28.01

0.001

cTnI: Troponin I, cTnT: Cardiac troponin T, CK-MB: Creatine kinase isoenzyme. Similarly hereinafter. Compared with before treatment, *P<0.05, **P<0.01.
2.2 Correlation among cTnI, cTnT and CK-MB concentrations and myocardial infarction area before treatment

Pearson correlation analysis suggested that these three myocardial enzymes were positively correlated with myocardial infarction area. They were shown in table 2.


Table 2 Correlation among cTnI, cTnT and CK-MB concentrations and myocardial infarction area before treatment in AMI patients




cTnI(μg/L)

cTnT(μg/L)

CK-MB(U/L)

r

0.99

0.98

0.95

P

0.001

0.001

0.001

AMI: Acute myocardial infarction. Similarly hereinafter.
2.3 Critical value of cTnI, cTnT, CK-MB for determining myocardial infarction range

Based on these three myocardial enzymes were significantly correlated with myocardial infarction range, further statistical analysis of QRS scoring system of patients found that these three myocardial enzymes and size of myocardial infarction area had clear critical value determining myocardial infarction range. They were shown in table 3.



Table 3 Critical value of cTnI, cTnT, CK-MB for determining myocardial infarction range in AMI patients

Infarct range (%)

cTnI(μg/L)

cTnT(μg/L)

CK-MB(U/L)

17%~34%

<1.70

<0.70

<28.00

35%~45%

1.70~2.30

0.60~0.90

27.00~41.00

46%~52%

>2.30

>0.90

>41.00


3. Discussion

Myocardial enzyme is a collective term of multiple enzymes existing in myocardium. The cTnI, cTnT and CK-MB are three important enzymes among them [5-6]. Heart is one of most active organs in human body, which possesses large amount of cellular enzymes to complete various physiological activities. After myocardial infarction occurs, because myocardial ischemia and necrosis or cell membrane permeability increases, making enzymes inside myocardium cell release into blood, elevating extent of serum enzymes depends on myocardial damage severity, therefore, changes of serum enzymes are used to reflect occurrence of myocardial infarction and size of lesion focus in clinic [7]. The present study demonstrates that, one week after AMI patients received PCI, along with patients’ symptoms continued improving, concentrations of theses three myocardial enzymes decreased in different degree compared with before treatment, and myocardial infarction area was controlled to some extent. Pearson correlation analysis indicated that abnormal degree of these three myocardial enzyme concentrations were positively correlated with myocardial infarction area of patients, correlation coefficients of cTnI, cTnT and CK-MB with infarct area were r1=0.99, r2=0.98 and r3=0.95 respectively, in another word, the higher abnormal concentrations of these three enzymes were, the larger myocardial infarction area was.

CK-MB is a kind of myocardial enzyme. When heart is impaired, serum CK-MB level elevates rapidly. Now it’s thought that in diagnosis of myocardial infarction, CK-MB possesses higher value, which is more reliable than ECG; cTnI and cTnT are a subunit of troponin, a specific modulating protein in myocardial tissue and specific serum markers reflecting myocardial damage [8]. When myocardial ischemia and damage occurs, troponin inside myocardial cells will release into blood, its contain rise rapidly and maintain for 1~2 weeks, which can be seen in myocardial infarction, acute angina pectoris, unstable angina pectoris or cardiac surgery etc., therefore, cTnI and cTnT are specific and sensitive indexes to determine whether myocardium is impaired or not, it’s superior to CK-MB and usually used as a gold index in diagnosing myocardial infarction.

Because cTnI and cTnI are subunits of troponin, therefore, they have no difference in diagnosing myocardial infarction; both of them can be used to identify myocardial damage which cannot be detected by CK-MB.

In summary, the present study proved that cTnI, cTnT and CK-MB are positively correlated with myocardial infarction area of patients. For determining myocardial infarction area, above indexes may provide reference, which is of important significance for early diagnosis and treatment of AMI.
Reference

[1] Di Serio F, Trerotoli P, Serio G, et al. Analytical evaluation of an automated immunoassay for cardiac troponin I: the Vidas Troponin I assay [J]. Clin Chem Lab Med, 2003, 41(10): 1363-1368.

[2] MA Hong. ECG analysis of acute myocardial infarction complicated complete bundle branch block [J]. J Clin Electrocardiol, 2013, 22(1):49-52.

[3] Li DW, Yu JF, Chen YJ, et al. Refolding and characterization of recombinant human GST-PD-1 fusion protein expressed in Escherichia coli [J]. Acta Biochim Biophys Sin (Shanghai), 2004, 36(2):141-146.

[4] QIN Qin, WANG Huai-zhou, HU Zhi-de, et al. Predictive value of red cell volume distribution width for short-term prognosis of patients with acute myocardial infarction [J]. Chin J Clin Lab Sci, 2012, 30(7): 515-517.

[5] XIAO Jun, TANG Fa-kuan, WANG Hong-ye, et al. Impacts of Xinmailong injection on acute myocardial infarction range and its clinical significance [J]. World J Integr Trad & West Med, 2011, 6(1):31-32, 62.

[6] Förhécz Z,,Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state [J]. Am Heart J, 2009, 158(4):659-666.

[7] WANG Yong, LIU Xiao-fei, LI Xian-lun, et al. Analysis of succumbed reasons of emergent percutaneous coronary intervention in treatment of acute myocardial infarction [J]. Chin J Emerg Med, 2006, 15(10):876-878.



[8] LIU Min-jie, QI Xian-yin, ZHANG Qiang, et al. Effect of GSK-3β overexpression on cardiac stem cell based therapy in myocardial infarction rats [J]. Chin J Public Health, 2013, 29(8):1184-1187.





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