Journal of Chest Surgery

  • 제31권2호
  • /
  • Pages.125-133
  • /
  • 1998
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  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

개심술환자에 있어 혈청 Troponin-T 농도의 변화에 관한 연구

Changes of Serum Troponin-T Concentrations in Patients with Open Heart Surgery

  • 박동욱 (인제대학교 부산백병원 흉부외과학교실) ;
  • 최석철 (인제대학교 부산백병원 흉부외과학교실내 체외순환연구실) ;
  • 김윤규 (인제대학교 부산백병원 흉부외과학교실) ;
  • 박종원 (춘해병원 흉부외과) ;
  • 조관현 (인제대학교 부산백병원 흉부외과학교실)
  • 발행 : 1998.02.01
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초록

이 연구는 심근손상이 예상되는 개심술 환자들을 대상으로 수술에 따른 TnT의 혈중내 농도변화를 추적하여 심근세포 손상의 진단적 지표로서의 유용성을 조사하였고 기존의 효소진단 방법인 CK-MB 백분율 및 LDH1/LDH2비와 유용성을 비교 검토하였다. 본 연구는 1996년 1월부터 1996년 6월까지 인제대학교 부산백병원에서 개심술을 받은 성인 환자 중 술전 혈청 TnT 농도가 정상 범위였던 30명을 선정하여 시간대별 채혈로 시행되었다. 연구의 목적에 따라 환자들을 I 군(대동맥 차단시간 60분 이하, n=15)과 II군(대동맥 차단시간 60분 이상, n=15)으로 나누어 비교 조사하여 다음과 같은 결과를 얻었다. 1. 혈청 TnT의 농도는 양 군 모두 수술 중 상승하여 대동맥 차단의 제거후 유의하게 증가하였다(p＜0.001). I 군에서는 술후 1일에 최고치(1.10$\pm$0.19 ng/ml)에 도달하였고 II 군에서는 체외순환 종료시 최고치(1.88$\pm$0.42 ng/ml)에 도달하여 이후 술후 7일까지 양군 모두 대조치에 비해 유의한 증가가 지속되었다(p＜0.01). 2. CK-MB/total CK(이하 CK-MB 백분율 이라 함)의 경우 양 군 모두 수술 시작과 함께 유의하게 증가하여(p＜0.001) 체외순환 종료시 최고치를 보였고 이후 술후 1일째까지 유의한 상승을 보였으나 술후 3일에는 기준치로 돌아옴으로써 혈청TnT에 비해 민감도가 떨어졌다. 3. LDH1/LDH2비는 수술동안 및 술후시기 전체에 걸쳐 대조치에 비해 유의한 변화가 없었다(p＞0.05). 4. 수술동안의 혈청 TnT 농도와 CK-MB 백분율 변화간에는 의미있는 상관관계를 보였다(r=0.64, p＜0.05). 5. I 군에 비해 II 군에서 혈청 TnT 농도는 대동맥 차단제거 시작 직전부터 술후 1일까지 유의한 증가를 보여(p＜0.05) 대동맥 차단 시간의 지속 정도가 심근세포 손상의 중요한 인자임을 확인할 수 있었다. 결론적으로 혈청 TnT는 심근세포 손상에 있어 유용한 기준지표가 됨으로 향후 급성심근 경색증의 진단 뿐만 아니라 개심술에 따른 심근세포 손상 정도의 예측과 술후 환자의 감시에 표식자로서의 중요성이 기대 되었다.

This study was designed to identify the efficiency of serum troponin-T(s-TnT) level as a diagnostic indicator for the perioperative myocardial damage with open heart surgery(OHS) and to compare with the conventional myocardial enzyme tests such as isoenzyme fraction of creatine kinase(% CK-MB) and isoenzyme ratio of lactate dehydrogenase(LDH1/LDH2 ratio). The study was performed on 30 adult patients who underwent OHS from Jan. 1996 to June 1996 at Inje University Pusan Paik Hospital, and they were divided into two groups accor- ding to aortic clamping time(ACT) duration : group I(ACT＜60 minutes, n=15); group II (ACT＞60 minutes, n=15). S-TnT, % CK-MB, and LDH1/LDH2 ratio were measured in serial blood samples from all subjected patients. The results were obtained as follows. 1. In both groups, s-TnT concentrations increased gradually during OHS and elevated significantly at CPB-10(p＜0.001). The peak level was noticed at POD 1 in group I(1.10 $\pm$0.19 ng/ml), whereas, at CPB-off in group II(1.88$\pm$0.42 ng/ml). The elevated levels remained until POD 7 in both groups. 2. %CK-MB was risen significantly with the initiation of operations(p＜0.001) and the peak levels were noticed at CPB-off in both groups(7.14$\pm$0.86% in group I, 10.69$\pm$1.27% in group II). Thereafter, these levels returned to normal values at POD 3. 3. There were no significant changes in the values of LDH1/LDH2 ratio during and after OHS compared with the control levels(p＞0.05). 4. The serial changes of s-TnT were relatively well correlated with those of changes of % CK-MB(r=0.64, p＜0.05). 5. The serial s-TnT levels were significantly higher in group II than group I from B-ACR to POD 1(p＜0.05), suggesting that duration of aortic clamping time was a major factor concerned with perioperative myocardial injury. In conclusion, measurement of s-TnT is a very useful indicator in assessing the myocardial cell damage and therefore it is expected that serial checking and evaluation of the s-TnT is very available for identification of the perioperative myocardial damage and for postoperative cares in patients with OHS.

키워드

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