Clinical Significance Of Changes Of Cardiac Troponin T And Other Biochemical Markers In Acute Ischemic Stroke Patients

Background and ObjectiveCerebrovascular disease is a threat to human health and one of the three major diseases,which account for 75%of cerebral infarction.In recent years,high blood pressure,arteriosclerosis,diabetes,cerebrovascular disease risk factors increased, leading to cerebral infarction morbidity and mortality increased year by year.A heart attack in the absence of primary after acute stroke can also cause heart damage and even lead to sudden death.The incidence of acute ischemic stroke after the first three months,died of cardiac causes in patients with up to 2%-6%.The most recent meta-analysis showed that patients with stroke each year of acute myocardial infarction and stroke non-vascular death rates were 2.2 percent and 2.1 percent.Stroke is currently related to the pathogenesis of myocardial damage is not yet clear,cardiac troponin T(cardiac troponin T,cTnT) is a myocardial damage sensitivity and specificity of strong indicators.After the acute stroke often caused by the body metabolism and endocrine inflammatory response,post-stroke by the TNF(tumor necrosis factor-α,TNF-α)-mediated inflammatory response may damage the myocardial cells in the second channel.At present,for acute stroke patients with serum cTnT,triiodothyronine(T3),TNF-αstudy of the relevance of literature less, our study was to observe the acute ischemic stroke patients with serum levels of cTnT and other Health Of markers such as serum T3,TNF-a levels to explore with its short-term prognosis,the severity of stroke related to each other.Subjects and methods1.General information:(1) From May 2006 to December 2007,all patients with an acute ischemic stroke admitted to the incidence of hospital within 48 hours of stroke onset were included, after brain CT has confirmed the diagnosis with the Chinese Medical Association in 1995 to the Fourth National Symposium on standard cerebrovascular disease of ischemic stroke.(2) To exclude the following cases:the recent myocardial infarction,heart failure, cardiac surgery,renal failure,pregnant women,severe dementia.(3) Of all patients did not undergo thrombolytic therapy2.Detection indicators:On admission to hosipital,a elbow venous blood sample to place 30 minutes after the centrifugal serum was obtained for the following tests.(1) cTnT monitoringApplicating of electrochemical immunoassay diagnostic(Elecsys 2010 the Swiss company Roche) can detect cTnT level,while detection limit of cTnT was 0.01 ng/ml. Myocardial damage to the diagnostic criteria was＞0.03ng/ml(2) T3 monitoringApplication of electrochemical immunoassay diagnostic(Elecsys 2010 the Swiss company Roche) can detect T3.T3 of the normal range was 0.6-1.8ng/ml.(3) TNF-αto monitorSerum samples transfemed to -20℃to focus and the analysis was performed by Enzyme-linked immunosorbent assay(ELISA) test.Rabbit anti-human tumor necrosis factor-a kit provided by the United States BPB.Sensitivity was 1.0pg/ml,as a normal＜65pg/ml.3.ElectrocardiogramECGs in 12-leads were obtained on admission,analysis by two professionals of the following:atrial fibrillation,atrial flutter,sinus tachycardia(HR＞120),sinus bradycardia(HR＜45),atrioventricular block,Ventricular fibrillation＞5S,ST elevated,ST decline,T-wave inversion,QT interval.4.The end of the follow-up observationSurvival in patients with acute stroke during and after discharge to follow-up phone records in the form of a month of sudden death and other events.Death is the primary endpoint of this study.At the same time,observed the end of the joint hospital death or non-fatal myocardial infarction,hospitalization or death during the acute non-fatal cardiovascular events such as myocardial infarction,or heart failure.5.In all the patients,age,sex,previous history of vascular risk factors,blood pressure,heart rate,body temperature were monitored from their arrived in hosilital.The neurological defict was graded using the National Institute of Neurological criteria(National Institutes of Health Stroke Scale,NIHSS).The aetiolgy of the stroke was classified according to the credit-based(TOAST) criteria into cardiac infarction,the main artery atherosclerotic stroke,small artery stroke and other causes of ischemic stroke,unexplained ischemic stroke.6.StatisticalStatistical analysis was performed using SPSS12.0 fpr Windows.Continuous variable to(?)±S said that the classification of variable rate or a percentage,cTnT compared with the use of different groups of independent samples t test,cTnT associated with the analysis of the factors used Pearson correlation analysis.Cox regression survival data applications for multi-factor analysis,conducted likelihood ratio test.P＜0.05,said the difference was statistically significant.results1.This study observed a total of 68 cases of patients(35 cases of male patients, average age 68±11.4 years old;33 cases of female patients,average age 69±10.3 years),according to the level of detection of cTnT divided into two groups,cTnT normal group of 54 cases(79.4%),cTnT positive group,14 cases(20.6 percent).The latter observation of the greatest value of 4.2ng/ml,median 0.21 ng/ml.2.CTnT positive and by the NIHSS score of neurological deficits was positively correlated(P＜0.001).cTnT positive correlation with heart rate,and there is statistical significance(P=0.033).3.CTnT with the level of red blood cells and hematocrit decline was statistically significant(P=0.001),with blood urea nitrogen,the white blood cell count, fibrinogen increase was statistically significant(respectively P=0.001,0.003,0.013). cTnT levels and T3 decreased(P＜0.001),TNF-a statistically significant increase(P＜0.001).4.T3,TNF-aAll the patients of T3 in the range of detection 0.55-1.78ng/ml,with a median of 0.86ng/ml,cTnT and a decline in T3 was a negative correlation(r=-0.324,P= 0.021).All patients TNF-a detection range of 8.63-124.75pg/ml,with a median of 68.42pg/ml,cTnT and TNF-a was a positive correlation(r=0.67,P=0.017).5.Follow-up of patients a month(an average of 26±4.3 days,21 days in the middle a few,in the range of 2-31 days),there will be 14.7 percent died in the hospital 11.7 percent,3.0 percent after discharge.Serum levels of troponin has nothing to do with the cause of death.6.After age,NIHSS adjustment cTnT remains an independent risk factor for death(RR=2.34,95%CI=1.22-5.02,P=0.0011 ).7.NIHSS score with T3,TNF-a related studyT3 and NIHSS score was a negative correlation(r=-0.521,P=0.002),NIHSS score with TNF-a positive correlation(r=0.673,P＜0.001).Conclusion1 Acute ischemic stroke,myocardial damage prompted the increase cTnT death in patients with vascular and non-fatal incident rate is higher than the normal group, statistically significant.2 Acute ischemic stroke after the T3 level,TNF-a levels associated with cTnT, suggesting that post-stroke inflammatory response and stress may play a role in both heart damage. 3 CTnT anomaly of the impact of higher short-term prognosis,as acute ischemic stroke short-term clinical observation of the poor prognosis indicators.