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目的探讨肌钙蛋白T(cTnT)在病毒性心肌炎(VMC)的诊断及病情观察方面的价值。方法对102例急性病毒性心肌炎患者进行入院后1、2、3周及3个月cTnT和心肌酶谱的动态研究;cTnT阳性率与心内膜心肌活检(EMB)病理检查诊断率的对照研究;cTnT与心电图(ECG)、及病程关系的研究。结果急性病毒性心肌炎患者在各检测期内血清cTnT的阳性率(45.1%,)较心肌酶谱各项目[肌酸激酶(CK)29.4%、肌酸激酶同工酶(CKMB)34.3%、门冬氨酸氨基转移酶(AST)10.9%、乳酸脱氢酶(LDH)13.7%、α羟丁酸脱氢酶(αHBDH)12.8%]显著增高(P<0.005,P<0.05);cTnT阳性率(45.1%,46/102)与心内膜心肌活检病理诊断率(40.6%,13/32)差异无统计学意义(P>0.05);cTnT阳性组ECG正常率(8.7%,4/46)明显低于阴性组(25%,14/56)(P<0.05);cTnT阳性组3个月的总治愈率(65.2%,30/46)明显低于阴性组(89.3%,50/56)(P<0.005)。结论在病毒性心肌炎的诊断中cTnT可取代传统的心肌酶谱测定;cTnT具有与心内膜心肌活检同样重要的诊断价值;cTnT在病毒性心肌炎病情观察中也具有重要意义。
Objective To investigate the value of troponin T (cTnT) in the diagnosis and observation of viral myocarditis (VMC). Methods The dynamic changes of cTnT and myocardial enzymes in 102 patients with acute viral myocarditis at 1, 2, 3 weeks and 3 months after admission were compared. The diagnostic value of cTnT positive rate and endocardial myocardial biopsy (EMB) ; cTnT and electrocardiogram (ECG), and the relationship between disease research. Results The positive rate of serum cTnT in patients with acute viral myocarditis (45.1%) was significantly higher than that in myocardial enzymes (29.4% of creatine kinase (CK), 34.3% of creatine kinase (CKMB) (P <0.005, P <0.05). The positive rate of cTnT was significantly higher than that of the control group (10.9%, AST, LDH and ALD) The positive rate of ECG in cTnT positive group (8.7%, 4/46) was significantly higher than that in endocardial myocardial biopsy (45.1%, 46/102) and endomyocardial biopsy (40.6%, 13/32) (65.2%, 30/46) in cTnT positive group was significantly lower than that in negative group (89.3%, 50/56) (P <0.05) (P <0.005). Conclusions cTnT can replace the traditional myocardial enzymogram in the diagnosis of viral myocarditis. CTnT has the same important diagnostic value as endocardial myocardial biopsy. CTnT is also of great significance in the observation of viral myocarditis.