心肌肌钙蛋白Ⅰ对小儿心肌炎的诊断价值及与肌酸激酶同功酶MB的对比研究

目的评估血清心肌肌钙蛋白I(cTnI)对小儿心肌炎的诊断价值,并与肌酸激酶同功酶MB(CK-MB)进行对比研究.方法全自动生化分析仪对cTnI及CK-MB进行定量检测.结果①心肌炎组cTnI及CK-MB均明显高于正常对照组(P＜0.001).cTnI升高22例,占73%,CK-MB升高15例,占50%,cTnI与CK-MB呈正相关.②治疗2周后cTnI与对照组比较有显著性差异(P＜0.001),CK-MB与对照组无显著性差异(P＞0.05).③心肌炎组13例ST-T改变患儿测cTnI升高12例(92%),CK-MB升高6例(46%).结论 cTnI及CK-MB对小儿肌炎的诊断均较敏感.cTnI诊断时间窗宽于CK-MB,特异性高于CK-MB.     

血浆miRNA-497在小儿脓毒症心肌损伤早期诊断中的应用价值

目的 探究生物标志物血浆miRNA-497在小儿脓毒症心肌损伤早期诊断中的价值。方法 回顾性分析2017年8月至2020年4月海南省妇女儿童医学中心收治的186例小儿脓毒症患者的临床资料,根据是否发生心肌损伤分为研究组(n=111,无心肌损伤组)和对照组(n=75,心肌损伤组)。比较两组患儿的血浆miRNA-497和常规心肌损伤实验室指标[心肌肌钙蛋白I(c Tn I)、肌酸激酶同工酶(CK-MB)、降钙素原(PCT)、左心室射血分数(LVEF)和C反应蛋白(CRP)]水平,并经受试者工作特征曲线(ROC)评估血浆miRNA-497对于小儿脓毒症心肌损伤的诊断价值,且经Pearson法分析血浆miRNA-497与c Tn I、CK-MB、LVEF和CRP的相关性。结果 研究组患儿的血浆miRNA-497(1. 61±0. 55 vs. 4. 35±0. 63)、cTnI(0. 06±0. 01 ng/ml vs. 4. 37±0. 51 ng/ml)、CK-MB(20. 36±5. 72 U/L vs.35. 78±4. 17 U/L)、PCT(12. 69±1. 15μg/L vs. 18. 36±1. 87μg/L)、CRP(140. 57±9. 38 mg/L vs. 171. 36±10. 28mg/L)均低于对照组,且其LVEF(56. 89%±2. 36%vs. 37. 52%±3. 21%)高于对照组,差异均具有统计学意义(P 0. 001)。血浆miRNA-497的心肌损伤诊断曲线下面积(AUC)高于CK-MB(0. 935 vs. 0. 769)(P 0. 001),与c Tn I(0. 935 vs. 0. 944)的AUC比较,无显著差异(P0. 05)。血浆miRNA-497的最佳阈值为2. 09时,其诊断心肌损伤的敏感度及特异度分别为92. 8%、97. 2%。经Pearson分析,血浆miRNA-497与c Tn I呈正相关(r=0. 715,P 0. 001),与LVEF呈负相关(r=-0. 692,P 0. 001)。结论 血浆miRNA-497有可能会作为小儿脓毒症心肌损伤诊断指标,该指标与c Tn I呈正相关、与LVEF呈负相关,且其敏感度及特异度均较高,表现出良好的诊断价值。     

血清心肌肌钙蛋白I诊断新生儿窒息心肌损害的研究

目的 :探讨血清心肌肌钙蛋白 I(c Tn I)诊断新生儿窒息心肌损害的临床价值。方法 :采用免疫化学发光测定法 (CL IA)检测正常对照组 (2 0例 )、轻度窒息组 (2 0例 )和重度窒息组 (2 0例 )新生儿血清 c Tn I浓度。结果 :1血清 c Tn I浓度在窒息新生儿有明显增高 (F=81 .0 7,P<0 .0 1 ) ;对照组 c Tn I(0 .0 5± 0 .0 4)μg/ L与轻度组 (0 .30± 0 .2 8)μg/ L、重度组 (2 .6 5± 2 .73)μg/ L之间两两比较均存在非常显著性差异 (P均 <0 .0 1 ) ;2 4例重度窒息合并有心力衰竭新生儿血清 c Tn I浓度显著增高分别为 4.1 8、5 .40、7.6 7及 1 0 .43μg/ L ,浓度为1 0 .43μg/ L的患儿死亡。结论 :1 c Tn I可作为新生儿窒息心肌损害新的诊断金标准 ,有助于早期诊断 ;2 c Tn I明显增高或许对新生儿窒息合并心衰的预后有参考价值。     

慢性肾功能衰竭患者血清肌钙蛋白水平变化及其对预后的评估价值

目的 探讨血清肌钙蛋白水平在慢性肾功能衰竭(CRF)患者重度异常变化及其对预后评估的价值。方法 选择2016年1月至2018年1月广州市第二人民医院收治的96例CRF患者为观察组,根据血透与否进一步分为血透组(44例)与非血透组(52例),另选择同期健康体检者50例为对照组。分别观察并比较两组患者血清中心肌肌钙蛋白T(c Tn T)、心肌肌钙蛋白I(c Tn I),肌酸激酶同工酶(CK-MB)及血清肌酐(Scr)水平变化。此外,随访观察组患者1年并记录心血管事件发生情况,比较有症状组患者上述指标与无症状组患者间的差异。结果 观察组c Tn T、c Tn I及Scr水平均显著高于对照组(P 0. 05),而两组CK-MB比较差异未见统计学意义(P 0. 05);非透析组Scr[(462. 16±35. 22)μmol/L]显著高于透析组[(323. 25±51. 09)μmol/L],但c Tn I[(0. 87±0. 34)μg/L]显著低于透析组[(1. 46±0. 21)μg/L],差异有统计学意义(P 0. 05)。两组c Tn T、CK-MB水平比较,差异未见统计学意义(P 0. 05);有症状组c Tn I显著高于无症状组(P 0. 05);余指标组间比较差异未见统计学意义(P0. 05)。结论 血清肌钙蛋白在CRF患者中有显著升高,其中c Tn I的显著升高提示心血管事件发生率较高,预后不佳。     

心肌型脂肪酸结合蛋白在诊断早期急性心肌梗死中的临床应用

目的:探讨疑似急性冠脉综合征(ACS)患者心肌型脂肪酸结合蛋白(H-FABP)在急性心肌梗死(AMI)早期诊断中的临床应用价值。方法 :回顾性分析深圳市龙岗中心医院急诊内科2010年7月至2013年5月疑似ACS患者143例的临床及血清H-FABP浓度变化资料。结果:在AMI发病3 h内,H-FABP的诊断敏感性(67.8%)优于c Tn I(0.0%)和CK-MB(0.0%),AMI发病4-6 h内,H-FABP敏感性(93.7%)仍高于c Tn I(60.9%)和CK-MB(51.2%)。AMI发病6 h内,H-FABP是最为敏感的心脏标志物,尤以发病3 h内,优于经典心肌损伤标志物c Tn I和CK-MB的诊断价值。结论:在早期诊断AMI的心脏标志物中,血清H-FABP的敏感性明显高于c Tn I和CK-MB,具有较高的特异性;在AMI发病3h内,H-FABP的诊断价值优于c Tn I和CK-MB。HFABP可作为AMI早期诊断的新指标。     

超声心动图Tei指数早期诊断小儿重症心肌炎的临床价值分析

目的探讨超声心动图Tei指数诊断小儿重症心肌炎的临床应用价值。方法回顾性选取160例确诊重症病毒性心肌炎患儿(病例组),病例收集时间2014年1月至2016年12月;另选同期80例儿保科收集的健康儿童作为对照组。采用超声心动图检测两组心功能指标、Tei指数、血清心肌酶学指标并进行比较分析,观察Tei指数与血清学指标的相关性。结果病例组患儿左右心室的Tei指数、等容收缩间期(ICT)、等容舒张间期(IRT)测定值均显著的高于对照组,差异有统计学意义(P0.05);病例组患儿左心室的射血时间(ET)显著的高于对照组(P0.05),病例组患儿的右心室ET显著的低于对照组(P0.05);病例组患儿血清肌酸激酶同工酶(CK-MB)、肌钙蛋白I(c Tn I)、肌酸激酶(CK)、乳酸脱氢酶(LDH)水平均显著的高于对照组(P0.05);病例组患儿血清CK、CK-MB、c Tn I、LDH水平与患儿左室Tei指数、右室Tei指数均呈显著的正相关关系(P0.05)。结论超声心动图Tei指数诊断小儿重症心肌炎具有一定的临床价值,并且与患儿心肌酶学指标具有较好的相关性。     

心绞痛肌钙蛋白I检测的临床评价

目的　观察心绞痛患者入院后血清肌钙蛋白 I(c Tn I)含量的变化 ,并评价其对患者预后的临床价值。方法　对 6 5例不稳定型心绞痛患者 (UAP)、35例稳定型心绞痛患者 (SAP)及 30例健康成年人分别进行血清 c Tn I、肌酸激酶同工酶 (CK- MB)测定 ,并分析其与心脏事件的关系。结果　 UAP患者中 c Tn I≥ 0 .1ng/ ml占 4 7.7% ,其中 30 d内4 5 .1%发生了心脏事件。 c Tn I<0 .1ng/ ml中 8.8%发生心脏事件 (P<0 .0 5 )。定量 c Tn I检测对预测心脏事件的敏感性为 76 .3%、特异性为 6 7.4 %、阳性预测值为 4 5 .6 %、阴性预测值为 87.8%、准确性为 6 9.5 %。结论　 c Tn I定量检测对判断 UAP患者短期内发生心脏事件有较好的预测价值。     

非缺血性心脏病并慢性充血性心力衰竭患者血清心肌肌钙蛋白Ⅰ的变化及意义

目的探讨非缺血性心脏病并慢性充血性心力衰竭 ( CHF)患者血清心肌肌钙蛋白 I( c Tn I)水平的变化 ,以指导非缺血性心脏病并 CHF的治疗和判断预后。方法 40例非缺血性心脏病并 CHF患者 ,分别于第 2天和心力衰竭稳定 5～ 7天各抽血 2 ml,用化学发光分析法测定 c Tn I水平 ,并与对照组进行比较。结果 CHF组血清 c Tn I水平为 1.16± 0 .77μg/L ,对照为 0 .2 0± 0 .0 8μg/L ( P<0 .0 1) ;CHF组阳性者治疗前 c Tn I水平为 1.38± 0 .75μg/L,治疗后为 0 .35± 0 .11μg/L,P<0 .0 1;血清 c Tn I水平随心力衰竭的程度加重而升高 ,血清 c Tn I持续阳性者 ,其预后不佳。结论非缺血性心脏病并 CHF患者存在心肌细胞损伤或坏死 ,血清 c Tn I水平是反映非缺血性心脏病并 CHF严重程度的一个可靠指标 ,同时识别其高危患者     

参麦联合舒血宁注射液治疗急性病毒性心肌炎疗效观察

目的:探讨参麦注射液联合舒血宁注射液治疗急性病毒性心肌炎患者的临床疗效。方法:选取我院91例急性病毒性心肌炎患者,随机分为对照组和观察组。对照组45例予以钾镁能量极化液+辅酶Q10胶囊治疗,观察组46例给予参麦注射液+舒血宁注射液治疗。比较两组治疗效果、心肌酶肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(c Tn I)水平及不良反应发生率。结果:观察组治疗总有效率高于对照组,CK-MB及c Tn I水平均低于对照组,差异具有统计学意义,P0.05;两组患者不良反应发生率无显著性差异,P0.05。结论:参麦注射液联合舒血宁注射液治疗急性病毒性心肌炎效果显著,可改善心肌功能,且安全性高。     

小儿急性心力衰竭心肌肌钙蛋白I的变化

198 7年 Commins将心肌肌钙蛋白I( c Tn I)用于临床诊断心肌损伤 ,有较高的灵敏度和特异性 〔1〕。国内外有 c Tn I在成人急性心力衰竭 (心衰 )有应用价值的报道〔2 ,3〕 ,在小儿心衰中的变化尚未见报道。为此我们对心衰患儿血清 c Tn I进行定量测定 ,观察 c Tn I与心衰的关系 ,探讨其临床价值 ,报告如下。1　资料与方法1.1　病例 :34例患儿为 1998年 6月～2 0 0 0年 6月收住我院儿科心血管病房诊断急性心衰者。诊断依据 1985年小儿心衰座谈会制订的标准〔4〕。男 19例 ,女15例 ;年龄 4个月～ 13岁 ,平均 ( 5 .7±2 .6 )岁 ;先天性心脏…     

Degradation of cardiac troponin I in serum complicates comparisons of cardiac troponin I assays.

BACKGROUND: Up to a 20-fold variation in serum cardiac troponin I (cTnI) concentration may be observed for a given patient sample with different analytical methods. Because more limited variation is seen for control materials and for purified cTnI, we explored the possibility that cTnI was present in altered forms in serum. METHODS: We used four recombinantly engineered cTnI fragments to study the regions of cTnI recognized by the Stratus(R), Opus(R), and ACCESS(R) immunoassays. The stability of these regions in serum was analyzed with Western blot. RESULTS: The measurement of several control materials and different forms of purified cTnI using selected commercial assays demonstrated five- to ninefold variation. Both the Stratus and Opus assays recognized the N-terminal portion (NTP) of cTnI, whereas the ACCESS assay recognized the C-terminal portion (CTP) of cTnI. Incubation of recombinant cTnI in normal human serum produced a marked decrease in cTnI concentration as determined with the ACCESS, but not the Stratus, immunoassay. Western blot analysis of the same samples using cTnI NTP- and CTP-specific antibodies demonstrated preferential degradation of the CTP of cTnI. CONCLUSIONS: The availability of serum cTnI epitopes is markedly affected by the extent of ligand degradation. The N-terminal half of the cTnI molecule was found to be the most stable region in human serum. Differential degradation of cTnI is a key factor in assay-to-assay variation.     

Tissue specificity of cardiac troponin I, cardiac troponin T and creatine kinase-MB.

The purpose of the paper is to review the tissue specificity of creatine kinase (CK)-MB, cardiac troponin I (cTnI), and cardiac troponin T (cTnT) in human and animal heart and skeletal muscle. Alterations are described which demonstrate that CK-MB is expressed in human skeletal muscle, and is not 100% specific for the heart. cTnI has been shown to be 100% specific for the heart. While cTnT isoforms are expressed in injured skeletal muscle, they are not detected by the diagnostic assays used in clinical practice. Therefore, cTnI or cTnT challenge CK-MB as the new standards for detection of myocardial injury.     

人心肌肌钙蛋白I的原核表达与纯化

目的构建人心肌肌钙蛋白Ⅰ（human cmdiac troponin I,hcTnI）原核表达载体并表达、分离纯化重组蛋白。方法RT-PCR从人心肌组织中克隆出hcTnI的cDNA序列构建到原核表达载体pQE30,获得重组表达质粒pQE30-hcTnI,并在大肠杆菌M15中诱导表达。镍凝胶亲和层析纯化目的蛋白,Western Blot杂交鉴定重组蛋白。结果经测序证实,获得的目的基因与（GeneBankM64247）公布的hcTnI基因序列一致。pQE30-hcTnI在大肠杆菌M15中经WFG诱导后表达出相对分子量约为29kD的目的蛋白,镍柱纯化后经抗hcTnI单克隆抗体进行Western印记,在相对分子量约29kD处可见特异性着色带。结论体外成功诱导了重组hcTnI蛋白表达,通过镍凝胶亲和层析法获得纯度较高的hcTnI蛋白,为进一步获得hcTnI的抗体及建立相应的临床快速检测方法奠定了实验基础。     

人cTnI抗原性及测定标准化的研究进展

上个世纪90年代起。心肌肌钙蛋白(cTn)用于临床诊断心肌损伤．由于心肌肌钙蛋白Ⅰ(cTnI)可检出微小心肌损害，现已成为心肌细胞损伤敏感度和特异度最强的标志物之一，是快速诊断急性心肌梗死(AMI)和急性冠脉综合征(acute coronary syndromes．ACS)、协助ACS危险分级和反映其预后的主要生化标志。大量临床研究表明cTnI在诊断心肌损伤时有高度的特异度及灵敏度。是诊断心肌损伤的“金标准”。     

Long-term biological variation in cardiac troponin I

ObjectivesTo determine the long-term biological variation (BV) of cardiac troponin I.Design and methodsThree samples separated by a mean of 8.7 ± 2.8 months from 17 patients seen in an outpatient clinic. Tropoinin I was measured using a high sensitivity assay from Singulex, Inc.ResultsThe long-term analytical, intra-assay and total variation were 15.2%, 27.9%, and 70.9%, respectively. The index of individuality (II) was 0.45, and the reference change value was + 98% and ? 50%, respectively.ConclusionThe BV over 9 months was comparable to previously published results over 2 months using the same testing methodology. The II indicates that reference range values are of less value than serial testing.     

Negative interference in cardiac troponin I immunoassays by circulating troponin autoantibodies

BACKGROUND: There are numerous potential sources of interference in immunoassays. Our aim was to identify the blood component that causes negative interference in cardiac troponin I (cTnI) immunoassays based on antibodies against the central part of cTnI. METHODS: We isolated an interfering factor (IF) from a sample with low recovery of added cTnI, using several consecutive purification steps: caprylic acid precipitation, ammonium sulfate precipitation, and purification on Cibacron Blue gel and protein G columns. Purified IF was identified by gel electrophoresis and mass spectrometric analysis of protein bands. For the direct detection of human antibodies to cardiac troponin in serum samples, we developed immunoassays using three different anti-human immunoglobulin antibodies and measured troponin antibodies in samples with low and normal cTnI recovery. RESULTS: Treatment with caprylic acid did not precipitate IF, but IF precipitated at 40% ammonium sulfate saturation. IF bound to a Cibacron Blue gel column, from which it was eluted with a linear salt gradient; it also bound to protein G. Gel electrophoresis of purified IF showed two major bands with molecular masses corresponding to the heavy (approximately 50 kDa) and light chains (approximately 25 kDa) of immunoglobulin, and their identities were confirmed by mass spectrometry. The presence of troponin-specific autoantibodies was confirmed in samples with low recoveries of cTnI by three different immunoassays. The median signals were significantly higher in 10 samples with low recovery than in 10 samples with normal recovery of cTnI (P < or = 0.007). CONCLUSIONS: Circulating autoantibodies to cTnI or other proteins of the troponin complex can be a source of negative interference in cTnI immunoassays.     

Analytical performance of the i-STAT cardiac troponin I assay

BACKGROUND: This study determines the analytical characteristics of the i-STAT cardiac troponin I assay (cTnI; i-STAT, Princeton, NJ), a 10-min POC assay, designed to be performed at the bedside. METHODS: Three different hospitals participated in a patient specimen and analytical validation study (n=186) for the i-STAT cTnI assay carried out in real time. A total of 186 whole blood specimens (lithium heparin) were collected from patients presenting with symptoms suggestive of acute coronary syndromes (ACS) for correlation studies as well as from 162 healthy subjects for reference interval determination. Factors studied included antibody specificity, detection limit, imprecision, linearity, assay specificity, sample type stability, interferences, reference limit determination and comparison vs. the Dade Stratus CS cTnI assay. RESULTS: Total imprecision (CV) of 10% and 20% were seen at 0.09 and 0.07 microg/l, respectively. The detection limit was 0.02 microg/l. The 99th percentile reference limit was 0.08 microg/l. The assay was not affected by common interferents. An equimolar response within 5% was found for reduced and phosphorylated forms of TIC and IC complexes. Regression analysis for the i-STAT cTnI between whole blood and plasma specimens and for whole blood between the i-STAT and Stratus CS cTnI assays demonstrated slopes of 1.06 and 0.89, respectively. CONCLUSIONS: The i-STAT cTnI assay is a sensitive and precise monitor of cTnI, poised for point-of-care/near bedside clinical utilization for triage, diagnostics and risk management of acute coronary syndrome patients.