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Objective Observation of the effects of Xinmailong injection on NGAL, hs-cTnT and RAAS in elderly patients with type 2 cardio-renal syndrome (CRS) , and EvaluatIon of the clinical efficacy and safety.Methods A total of 86 elderly patients who were collected from November 2015 to February 2017 were diagnosed as type 2 CRS in our department of geriatrics. According to the random number table method, they were randomly divided into two groups. Control group (43 cases) were treated with conventional medical therapy and xinmailong group (43 cases) were treated with xinmailong injection with a dose of 5 mg/kg twice a day for 15 days. The value of sneutrophil gelatin-associated apolipoprotein (NGAL) , hypersensitive troponin T (hs-cTnT) , brain natriuretic peptide (BNP) , plasma renin activity (PRA) , and angiotensin Ⅱ (Ang Ⅱ) , aldosterone (ALD) , left ventricular ejection fraction (LVEF) , six-minute walking test and other indicators were measured before and after treatment. Results After treatment, the value of NGAL, hs-cTnT, BNP, PRA, AngⅡ and ALD decreased in both groups, the value of LVEF and six-minute walking distance increased compared with those before treatment (P <0.05); The above indicators in the xinmailong group experienced a more significant alteration than in control group in the same period (P < 0.05); no side effect occurred in both two groups during the experiment. Conclusion Xinmailong injection can reduce the levels of NGAL, hs-cTnT and BNP in elderly patients with type 2 cardio-renal syndrome, improve heart and kidney function, and have curative positive effect and good safety. This study underlined the mechanism of Xinmailong injection may be related to the inhibition of RAAS activity.
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Objective The aim of this study was to evaluate the diagnostic value of rule-out strategy for acute myocardial infarction (AMI) in chest pain patients with normal high-sensitivity troponin T (hs-cTnT).Methods Adults presenting chest pain to the West China hospital of Sichuan university from January 2016 to January 2017 were enrolled.Clinical data including ECG and hs-cTnT concentration was obtained.The diagnostic value of three strategies were evaluated.The optimal rule-out strategy for AMI were finally established in chest pain patients.Results A total of 153 patients were enrolled.In patients with chest pain time less than 5 h,the first hscTnT level was less than 14 ng/L.The negative predictive value (NPV) of 0/3 h dynamic observation and 5 minus the time of chest pain were 100％.The NPV was 99.8％ to rule-out AMI directly using the first hs-cTnT level.Conclusions For patients with chest pain time less than 5 h,the first hs-cTnT level less than 14 ng/L,0/3 h dynamic observation and the strategy of 5 h minus chest pain time have the same diagnosis value for ruling out AMI alternatively.It was not suggested to use the first hs-cTnT level to rule out AMI .
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Objective To investigate clinical value of high sensitive-cardiac troponin T(hs-cTnT) combined with creatine kinase isoenzyme MB(CK-MB) in the diagnosis of children with myocarditis.Methods From Nov.2014 to Nov.2015,a total of 102 cases of myocarditis,suspected with myocardial damage and without myocardial damage(pneumonia and capillary bronchitis),and 50 healthy children were enrolled.Plasma levels of hs-cTnT and CK-MB were detected and compared.Results The levels of plasma hs-cTnT and CK-MB in children with myocarditis were significantly higher than those without myocarditis and healthy subjects(P<0.05).Hs-cTnT and CK-MB levels in children with myocarditis,less than one month old,were significantly higher than those with age of 1 month to 3 years old(P<0.05).Conclusion Combined detection of hs-cTnT and CK-MB could be with high sensitive and specificity in diagnosis of children with myocarditis,accurately assess the disease condition and improve the therapeutic effect and prognosis,which might be worthy of clinical application.
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Objective To investigate the difference of late-phase of limb ischemia preconditioning (L-LIP) verse early-phase (E-LIP) on patients with percutaneous coronary intervention (PCI).Methods A total of 160 patients with unstable angina pectoris who were planned to undergo PCI were divided equally into two groups at random.The late-phase of limb ischemia preconditioning group (80 patients) were provided with L-LIP (three 5-minute inflations up to 200mmHg by applying the sphygmomanometer cuff around the right upper arm,followed by 5-min intervals of reperfusion,twice a day) 3 days before PCI.The Earlyphase of limb ischemia preconditioning group (80 patients) were provided with E-LIP (method as above)2 hours before PCI.Comparison of procedural parameters during PCI and the levels of cTnT,CK-MB,hs-CRP were made 24 hours after PCI.Estimation of the rate of adverse events at 1 year between the two groups was evaluated by Kaplan-Meier analysis.Results Compared to the E-LIP group,the rates of angina,arrhythmia and TIMI flow ≤ 2 during PCI were significantly lower in the L-LIP group (all P ＜ 0.05).At 24 hours after PCI,the levels of cTnT and CK-MB were declined more significantly in the L-LIP group[(11.52±2.41) pg/ml vs.(27.53±4.78)pg/ml,P =0.021;(14.11±2.87)Iu/L vs.(30.23±5.17)Iu/L,P =0.032].There was no difference in the level of hs-CRP between the 2 groups [(128±0.71)mg/dl vs.(1.33±0.69)mg/dl,P =0.742].The Kaplan-Meier survival curve showed that the incidence rate of adverse events in the L-LIP group at l year was lower than the E-LIP group (3.75％ vs.13.75％,P =0.024).Conclusions L-LIP is more effective to in protecting myocardial cell in patients with unstable angina pectoris undergoing elective PCI and may reduce the rate of future adverse event.
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Objective To explore the clinical value of hs-CTnT among acute myocardial infarction patients.Methods 60 acute myocardial infarction patients were treated from July 2014 to October 2016 in our hospital, set as the observation group where venous blood samples were collected on admission, 4 hours after admission, 12 hours after admission and the control group (60 health human where the venous blood samples were collected in the morning), respectively.The hs-CTnT, myohemoglobin, creatine kinase isoenzyme and tropnin T were recorded for analysis.Results On arrival of hospital, the positive rate of CK-MBmass, Myo, hs-cTnT, cTnT was 75.0%、71.7%, 90.8%, 80.0%, respectively.Hs-cTnT positive rate raised to 100.0% and CK-MBmass (83.3%), Myo (75.0%), cTnT (88.3%) after 4 hours.Besides, after hospitalization, the hs-cTnT positive rates raised up.The rates apparently increased at different times (P<0.05).The positive predictive value was 90.0% and sensibility 91.0%, which was significantly higher than other indicators (P<0.05).Conclusion The high sensitivity and specify of hs-cTnT indicator level could be one of the early diagnosis index for acute myocardial infarction.
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Objective To detect hs‐cTnT and cTnI for exploring their application value in the early diagnosis of acute myocardial infarction(AMI) .Methods From October 2015 to March 2016 ,100 patients with AMI in the cardiology department of our hospital were selected as the observation group(AMI group) and contemporaneous 100 adults undergoing physical examination as the con‐trol group .The chemiluminescence immunoassay was used to detect the levels of hs‐cTnT and cTnI .The positive rate ,sensitivity and specificity of the hs‐cTnT and cTnI in the AMI group for early diagnosis of AMI were compared .Results The level of hs‐cT‐nT in the AMI group was (4 .89 ± 1 .83)ng/mL ,which was higher than that in the healthy population by 99 percentile value 0 .014 ng/mL ;the cTnI level in the AMI group was (28 .82 ± 12 .32)ng/mL ,which was higher than that in the healthy population by the upper limit of normal reference value 0 .4 ng/mL ,both of them were significantly higher than those in the control group ( P<0 .05) ,the positive rate and sensitivity of hs‐cTnT was both 92 .0% ,which was significantly higher than 79 .0% of cTnI both(P<0 .05) ,the specificity of cTnI was 96 .0% ,which was significantly higher than 76 .0% of hs‐cTnT(P<0 .05) .Conclusion The pos‐itive rate and the sensitivity of hs‐cTnT are high ,the specificity of cTnI is high ,their joint detection has an important significance for the early diagnosis of AMI .
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Objective To investigate the myocardial injury in the early stage of acute dichlorvos poisoning in rats. Method A total of 24 Sprague Dawley rats were randomly (random number) divided into control group(n = 12) and poisoning group(n = 12). Hemodynamic variables were monitored by using an arterial cannula inserted into right arteria carotis communis. Serum levels of cardiac troponin T(CTnT) and brain natriuretic peptide (BNP) were measured. Myocardial tissue was observed with HE stain under microscope. Results The rats of poisoning group showed that the heart rate (HR) and maximum ascending rates of left ventricular pressure(+ dp/dtmax)were significant decreased in an hour after poisoning (P ＜0.01). The maximum descending rates of left ventricular pressure(-dp/dtmax)and left ventricular end diastolic pressure (LVEDP)were markedly increased (P＜0. 01) and reached peak in 7 minutes in the poisoning group. Compared with the control group, cardiac troponin T obviously changed in rats poisoned with dichlorvos in the first hour. BNP was not affected after poisoning(P ＞ 0. 05). Myocardial damage was found in the poisoning rats.Conclusions Myocardial injury and heart failure occurred in the early stage of acute organophosphorus pesticides poisoning(AOPP) in rats. CTnT could play a major role in AOPP while BNP might not be involved in.
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Objecitve To investigate the relationship between placental growth factor and acute coronary syndrome(ACS). Methods 70 cases of patients with acute chest pain were enrolled. 36 cases of patients who is posi-tive on cardiac troponin T(cTnT) as treatment group, 24 patients who is negative on cTnT as control group, blood of all patients were detected about PLGF and cTnT in hospital,and coromary angiography examination, Gemini score is used to evaluate coronary artery lesion. Result PLGF and cTnT were elevated in ACS, it had significant difference between two groups(P <0. 01) ,PLGF and cTnT are significantly positive correlated(r= 1.2,P <0. 01), PLGF and cornorary artery lesion severity are significantly positive correlated(r = 1 ,P <0. 01). Conclusion PLGF is helpful to predict ACS attack to comorary heart disease,higher PLGF predicts unstable to coronary artery lesion in coronary heart disease.
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Background and Purpose: Elevation of serum cardiac troponin T (cTnT) is regarded as a specific marker of acute coronary syndrome. Serum cTnT can be increased in patients with acute ischemic stroke, but its clinical implications remain unclear. The aim of this study was to identify the relationships between elevated cTnT and stroke severity, location, and prognosis. Methods: From January 2005 to December 2006, this study recruited 455 consecutive patients who were admitted to Kangbuk Samsung Hospital due to acute ischemic stroke within 3 days of onset, which was confirmed by diffusion magnetic resonance imaging. A total of 416 patients was finally included and divided into 2 groups: an elevated cTnT group (n=45) and a normal cTnT group (n=371). The short-term prognosis was assessed by 30-day modified Rankin Scale responder analysis was compared between the two groups. Results: Serum cTnT was elevated in 10.8% of cases, with elevated cTnT associated with greater stroke severity, as assessed by the National Institutes of Health Stroke Scale score, Insular-lobe involvement was more common in patients with elevated cTnT than in the normal cTnT group. Short-term prognosis was more unfavorable in the elevated cTnT group than in the normal cTnT group. Multivariate regression analysis indicated that elevated cTnT was independently related to insular involvement, cardioembolism, and unfavorable outcome. Conclusions: Elevated cTnT in acute ischemic stroke was associated with severe neurological deficits at stroke onset and damages to the insular lobe. The outcome of acute ischemic stroke was worse for patients with elevated cTnT than for those with normal cTnT. The pathomechanism underlying acute ischemic stroke and subclinical myocardial damage warrants further study.
Subject(s)
Humans , Acute Coronary Syndrome , Diffusion Magnetic Resonance Imaging , Prognosis , Stroke , Troponin , Troponin TABSTRACT
Objective To detect the loss of cardiac troponin T (CTnT) in human myocardial infarction. Methods Loss of cardiac troponin T in human myocardial infarction was detected by immunohistochemical LSAB method. Results Obvious depletion of CTnT was observed in cases died from myocardial infarction,and by the computer image analysis, the mean CTnT-depleting area in myocardial infarction group was significantly different from that in the control group(P
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BACKGROUND: Despite of the high prevalence of cardiac disease, diagnosing and predicting myocardiac infarction in maintenance dialysis patients may be difficult. The availability of cardiac troponin T (cTnT) and cardiac troponin I(cTnI) offered promise for improving the accuracy of myocardial injuries in the ESRD patients. We hypothesized that cardiac troponin T and I might be useful markers of myocardial injury for patients with dialysis. METHODS: We examined several clinical parameters to identify factors that determine cTnT and cTnI in dialysis patients. The study included 63 patients who had been on dialysis without evidence of myocardial damage for minimum 3 months. Patients were assessed using demographic, cardiac and atherogenic indices including CPK, CK-MB, CK index, LDH, homocysteine, total cholesterol, triglyceride and serum albumin level. All patients were undertaken EKG and echocardiography. Serum levels of cTnT and cTnI were measured by electrochemiluminescence immunoassay(ECL) and chemilumino immunoassay(CLIA) method. We estimated the correlation between cTnT and cTnI with several parameters by using Pearson correlation, linear correlation and Chi- square analysis. RESULTS: The results are summarized as follows : The positivity of serum cTnT was higher in HD patients than CAPD(32% vs. 18%). But there was no significance statistically. Serum cTnI was elevated(>or=0.1 ng/mL) in only one HD patient. Serum cTnT inversely correlated with serum albumin levels (p or=0.1 ng/mL) in only one diabetic patient. We could not find the significant correlation between serum cTnT and cTnI with age, sex, dialysis mode, duration of dialysis, serum CPK, CK-MB, CK index, LDH, homocysteine, total cholesterol and triglyceride. CONCLUSION: Because cTnT revealed significant correlation with serum albumin and underlying diabetes mellitus. So we speculated that cTnT possibly might be a helpful marker as a predictor of myocardial event and mortality in maintenance dialysis patients. But we can not exclude false positivity of cTnT. And we are currently working to define that cTnI might be more specific marker of myocardial damage than cTnT and the development of cardiac event in cTnT-positive patients.
Subject(s)
Humans , Cholesterol , Diabetes Mellitus , Dialysis , Echocardiography , Electrocardiography , Heart Diseases , Homocysteine , Infarction , Kidney Failure, Chronic , Mortality , Prevalence , Serum Albumin , Triglycerides , Troponin T , TroponinABSTRACT
BACKGROUND: The main cause of death in maintenance hemodialyzed patients is cardiovascular event. Serum cardiac troponin T(cTnT) and I(cTnI) are increased in the serum of patients with chronic renal failure. METHODS: We studied the incidence of increased serum cTnT and cTnI, the differences of their positivity, and the myocardial injury and cardiovascular risk factors in 56 maintenance hemodialyzed patients (30 males, 26 females). We investigated the patients about smoking, diabetes, hypertension and anginal pain. Blood was obtained from the patients immediately before hemodialysis. Samples were analyzed for myoglobin, CPK, LDH, total cholesterol, hemoglobin, PTH, cTnT and cTnI. Also, we evaluated the duration and adequacy(Kt/V(urea)) of dialysis and ECG. cTnT was measured by ECLIA(reference value Subject(s)
Humans
, Male
, Cause of Death
, Cholesterol
, Dialysis
, Electrocardiography
, Hyperparathyroidism, Secondary
, Hypertension
, Incidence
, Kidney Failure, Chronic
, Myocardial Ischemia
, Myoglobin
, Renal Dialysis
, Risk Factors
, Sensitivity and Specificity
, Smoke
, Smoking
, Troponin I
, Troponin T
, Troponin
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PURPOSE: Generally, if a patient suffers from chest pain and shows a specific EKG pattern, it is easy to determine a clinical diagnosis, thus it is but in many cases, patients show nonspecific chest pain and a nonspecific EKG pattern. So it's important to consider the serological labaratory exam for cardiac enzymes for a definite diagnosis. Until now, cTnI has been considered to be different from CK-MB and cTnT in that it shows a specific elevation in early myocardiac injury and rare nonspecific elevation in renal-failure patients. Therefore, to affirm a sufficient relation between cTnI elevation and myocardiac injury, are carried out this study. METHODS: The number of patients in the study was 58. No one had shown any evidence of myocardiac injury during the recent 2 years or any of the risk factors for AMI, such as smoking, obesity, and hypercholesterolemia. They showed specific symptoms like chest pain or nonspecific ones like dyspnea, indigestion, or a nonspecific EKG abnormality, including nonspecific ST-T change. Their serum creatinine level was above 2.0 mg/dL and qualitative results of cTnI was obtained by using a Troponin I rapid assay kit. The definite diagnosis of AMI was made by a cardiologist based on an intergrated result of EKG, clinical symptoms and signs and regional cardiac wall-motion abnormality on a echocardiogram. RESULTS: The sensitivity of CK-MB, cTnT, and cTnI were 100%, 100%, and 100%, respectively, and the specificities were 75%, 85%, 100%. CONCLUSION: In cases of patients with a high serum-creatinine level, particularly, those with positive serum CK-MB and cTnT, the measurement of cTnI is considered to be significant for the differential diagnosis of AMI as it shows both a high sensitivity and a high specificity in early myocardiac injury.
Subject(s)
Humans , Chest Pain , Creatinine , Diagnosis , Diagnosis, Differential , Dyspepsia , Dyspnea , Electrocardiography , Emergencies , Hypercholesterolemia , Myocardial Infarction , Obesity , Renal Insufficiency , Risk Factors , Sensitivity and Specificity , Smoke , Smoking , Troponin I , TroponinABSTRACT
Objective To obtain high pure myocardiac Troponin T from myocardiac tissue. Methods After the myocardiac tissues were homogenized and purified with high salt solution, the Sephacryl S-300HR column chromatography was employed to separate the cTnT from cardiac proteins, and identified them with SDS-PAGE and Western blot. Results The crude cTn was purified by column chromatography, and there appeared three peaks. The second peak was single component, which could react with mouse anti-human Troponin T antibody, and its molecular weight was about 34kD. Conclusions In this experiment, high pure cTnT was obtained, which could pave a way for further research.
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Serum cTnT, CK-MB and LDI were measured in 30 patients with AMI, 76 patients with VMC, 12 patients who had undergone operation without cardioplegia, 16 patients who had received open heart operation, 15 patients who had undergone thoracotomy for non-heart surgery and 55 healthy people. Concentration of serum cTnT was 0.057±0.056 μg/L in healthy people,0.069±0.032 μg/L in patients who underwent thoracotomy for non-heart surgery, 0.328±0.472μg/L in patients with VMC, 0.388±0.279 μg/L in patients with DCM, 4.259±4.619 μg/L in patients with AMI, 8.55±6.78 μg/L in patients who had undergone operation without cardioplegia and 16.03±6.01 μg/L in heart operation patients. In patients with VCM and DCM, serum cTnT was more specific and sensitive than CK-MB and LDI for diagnosing myocardial injury. In patients with AMI and heart operation patients, the increasing multiple of serum cTnT was obviously higher than that of CK-MB and LDI. 72 h after heart operation, cTnT was still higher than normal, while CK-MB had returned to normal level. Serum cTnT had higher specificity and sensitivity and longer diagnostic period in diagnosing myocardial injury. Moreover, cTnT assay could indicate the degree of myocardial injury. So, quantitative analysis of cTnT can be used as a routine examination in the diagnosis of myocardial injury.
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Serum cTnT, CK-MB and LDI were measured in 30 patients with AMI, 76 patients with VMC, 12 patients who had undergone operation without cardioplegia, 16 patients who had received open heart operation, 15 patients who had undergone thoracotomy for non-heart surgery and 55 healthy people. Concentration of serum cTnT was 0.057±0.056 μg/L in healthy people,0.069±0.032 μg/L in patients who underwent thoracotomy for non-heart surgery, 0.328±0.472μg/L in patients with VMC, 0.388±0.279 μg/L in patients with DCM, 4.259±4.619 μg/L in patients with AMI, 8.55±6.78 μg/L in patients who had undergone operation without cardioplegia and 16.03±6.01 μg/L in heart operation patients. In patients with VCM and DCM, serum cTnT was more specific and sensitive than CK-MB and LDI for diagnosing myocardial injury. In patients with AMI and heart operation patients, the increasing multiple of serum cTnT was obviously higher than that of CK-MB and LDI. 72 h after heart operation, cTnT was still higher than normal, while CK-MB had returned to normal level. Serum cTnT had higher specificity and sensitivity and longer diagnostic period in diagnosing myocardial injury. Moreover, cTnT assay could indicate the degree of myocardial injury. So, quantitative analysis of cTnT can be used as a routine examination in the diagnosis of myocardial injury.
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BACKGROUND: Nonspecific elevations of CK-MB, cTnT have been well known in patients with chronic renal failure(CRF) on maintenance hemodialysis. It has been suggested that recently developed cTnI seldom shows nonspecific elevations in these patients. Status of CRF patients can be divided into three groups: predialysis group, hemodialysis group and peritoneal dialysis group. Until now, most researchers have studied CK-MB, cTnT and cTnI only in CRF patients receiving maintenance hemodialysis. No previous studies have ever compared the differences of the nonspecific positivity of CK-MB, cTnT and cTnI according to the different status of CRF patients. METHODS: Nonspecific positive ratios of cTnI, cTnT, & CK-MB in were evaluated 20 predialysis patients, 13 CAPD patients and 20 hemodialysis patients. No one had had any evidence of myocardial ischemia during the previous 3 months before the study entry. The predialysis group was again divided into two groups according to the cut off level of serum creatinine of 3.0 mg/dl. Authors also compared the nonspecific positive ratios of cTnI, cTnT, CK-MB between diabetic CRF group and non diabetic CRF group. The sensitivity, specificity and false positive ratios of each enzymes were examined on and 6 hours after arrival in 21 CRF patients who visited the emergency room with the complaint of chest pain. RESULTS: 1) There were no nonspecific significant elevations of cTnI in CRF patients regardless of the status of CRF. But there were significant nonspecific elevations of CK-MB, cTnT in them. It was more marked in cTnT especially with the cut-off value of 0.1 ng/ml. 2) Nonspecific positive ratios of cTnT was significantly increased in diabetic CRF patients. 3) The sensitivity and specificity of cTnI were 100% and 93.3% each, which were significantly higher than those of CK-MB(83.3%, 66.7%) & cTnT(66.7%, 53.3%). CONCLUSION: In CRF patients, the nonspecific positive ratios of CK-MB, cTnT were higher than that of cTnI, and only cTnI did show significant specific elevations in all the CRF patients with acute myocardial infarction. It is likely that the status of CRF patients, dialysis mode, the sampling time point would not give significant changes in the nonspecific positive ratios of CK-MB, cTnT and cTnI.