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目的 探讨急性心肌梗死患者尿激酶溶栓治疗过程中血清肌红蛋白 (Mb)的变化 ,判断其是否可以作为早期、非侵入性判断冠脉再灌流的指标。方法 对 2 2例尿激酶溶栓治疗和2 2例保守治疗的AMI患者治疗前后的 1h、2h、4h、8h、12h、14h、15h、18h和 2 4h的血清Mb进行测定 ,同时测定血清磷酸肌酸激酶同工酶 (CK MB) ,比较再灌流组和未再灌流组血清Mb的峰浓度和达峰时间 ,并同CK MB进行比较。结果 再灌流组血清Mb和CK MB的峰浓度分别为 6 19 5 9±198 5 5ng/ml和 15 7 10± 36 19u/L ,均显著高于未再灌流组 (487 31± 6 0 87ng/ml和 141 80± 2 2 18u/L) ;再灌流组较未再灌流组血清Mb达峰时间明显提前 (192min对 480min ,P <0 0 1) ,再灌流组血清Mb达峰时间显著早于血清CK MB达峰时间 (192min对 72 0min ,P <0 0 1) ,而且Mb的 2h出现率 (Mb2 /Mb0 )较未再灌流组也显著增高 (4 2 4对 2 12 ,P <0 0 1)。结论 血清Mb值早期上升、快速达峰是一种可靠、简便的非侵入性判断AMI再灌流治疗成功与否的指标。
Objective To investigate the changes of serum myoglobin (Mb) in patients with acute myocardial infarction treated with urokinase thrombolysis and to determine whether it can be used as an indicator of early and noninvasive coronary reperfusion. Methods Serum Mb at 1, 2, 4, 8, 12, 14, 15, 18 and 24 hours before and after treatment of 22 patients with urokinase thrombolysis and 22 conservative treatment was measured before and after treatment. The levels of serum phosphoric acid Creatine kinase isoenzyme (CK MB). The peak concentration and peak time of serum Mb in the group of reperfusion and non-reperfusion were compared and compared with CK MB. Results The peak concentrations of Mb and CK MB in the reperfusion group were 6 19 5 9 ± 198 5 5 ng / ml and 15 7 10 ± 36 19 u / L, respectively, which were significantly higher than those in the non-reperfusion group (487 31 ± 6 0 87ng / ml and 141 80 ± 2 2 18u / L respectively). Serum Mb peak time was significantly earlier in reperfusion group than in non-reperfusion group (192min vs. 480min, P <0.01) Serum CK MB peaked at 192 min (72 0 min, P 0 01), and Mb 2 h (Mb 2 / Mb 0) was significantly higher than that of the non-reperfusion group (42 24 vs 21 0, P <0 0 1). Conclusions Serum Mb value rises early and rapid peak is a reliable and simple noninvasive indicator to judge the success of AMI reperfusion therapy.