관동맥 질환에서 혈청 Troponin T 의 임상적 의의

Objectives: Although the diagnosis of coronary heart disease is usually straight forward, conventional diagnostic tests, such as CK, CK-MR, LDH, and AST have several drawbacks. The diagnostic efficiency of these conventional thests is disappointingly low, especially in minimal myocardial damage. l herefore, there has be necessity of more sensitive and specific diagnostic thest. Recently, cardiac TnT (TnT) was introduced with better sensitivity, specificity, and more wide diagnostic window. So we analyzed distribution of TnT in control, release kinetics, diagnositic significance of TnT in coronary heart disease including unstable angina and acute myocardial infarction, and efficiency of TnT as a marker of reperfusion in acute myocardial infarction. Methods: We tested cardiac TnT in 40 normal healthy subjects and 25 extracardiac traumatic patients as control group. We also tested cardiac TnT in 34 patients with acute myocardial infarction and 27 patients with unstable angina. We evaluated the distribution and serial change of cardiac TnT with other cardiac enxzymes after chest pain onset, the discriminant power of Tnl in discriminating of reperfusion after thrombolytic therapy in patients with acute myocardial infarction with conventional coronary angiography and the correlation between release kinetics of TnT and left ventricular ejection fraction with echocaroliography. Results: 1) In control group, all 65 cases serum TnT value were less than 0.2㎍/L. And its specificity (100%) and sensitivity in diagnosis of coronary heart disease including untable angina(acute myocardial infarction: 100%, unstable angina 70.4%) was better than those of other cardiac enzymes, such as CK, CK-MB. 2) In patient group, the release pattern of cardiac TnT was in bimodal curve pattern, while the pattern of other cardiac enzymes was in unimodal pattern. 3) In acute myocardial infarction, the first peak value of cardiac TnT appeared siginificantly earlier (9.53±2.36 hr in stable-reperfused group, 13.40±1.92 hr in non-reperfused group of acute MI than that of caridac enzymes; CK(17.65±6.48 hr in stable-reperfused group 27.53±10.26 hr in non-reperfused group), and CK-MH (16.84±7.93hr in stable-reperfused group, 24.33±10.36 hr in non-reperfused group of acute MI)(p