Increased Troponin-Ⅰ as an Indicator of Myocardium Injury in A Patient with Severe Carbon Monoxide Poisoning-A Case Report

嚴重一氧化碳中毒患者檢測肌鈣蛋白病例報告

戴世澤(Shih-Tse Tai) ； 羅瓊雲(Chiung-Yun Lo) ； 孫子賢(Tzu-Hsien Sun) ； 陳興漢(Shing-Han Chen)

《內科學誌》 19卷4期 (2008/08) Pp. 355-359

https://doi.org/10.6314/JIMT.2008.19(4).10

摘要

肌鈣蛋白(Troponins)是診斷急性心肌梗塞的重要標記。Ⅰ型肌鈣蛋白(TnⅠ)是存在於心臟肌肉細胞內之調節蛋白質，因此當心肌細胞受損時，血清中肌鈣蛋白數值便會昇高。實證醫學顯示，雖病人心電圖未呈現STT節段上昇，若檢测血清Ⅰ型肌鈣蛋白昇高時，在診斷急性心肌梗塞之正確率達100%，而檢到血清T型肌鈣蛋白昇高，則診斷正確率達75%。醫師平時針對一氧化碳中毒患者之醫療處置，若患者沒有胸部不適，或心電圖STT節段的無異常變化，並不會常規檢测血清Ⅰ型肌鈣蛋白。本文爲探討一名20歲原身體健康狀況良好的軍人，因懷疑一氧化碳中毒，檢到血清中Ⅰ型肌鈣蛋白上昇，而診斷爲急性心肌梗塞。特提出報告，藉能拋磚引玉，有更大規模研究來確立嚴重一氧化碳中毒病患，檢驗肌鈣蛋白的重要性。

並列摘要

Myocardial injury can be identified by elevated serum level of troponin, a regulatory protein of thin actin filaments of the cardiac muscle. In patients with inconclusive electrocardiogram (ECG) finding (i.e., no ST-segment elevation), a positive troponin Ⅰ (Tn Ⅰ) is 100% and troponin T (Tn T) is 75% predictive of acute myocardial infarction. In daily practice, physicians would not routinely check serum Tn Ⅰ level in patients suffering from carbon monoxide (CO) intoxication if patients do not complain of chest discomfort or when ECG examination shows no significant ST-segment changes. We report a 20-yearold previously healthy soldier with CO intoxication. Acute myocardial infarction was diagnosed by elevated serum Tn Ⅰ that was further supported by typical serial cardiac enzyme changes, and severe systolic hypokinesia of left ventricle in echocardiogram. This case suggests the importance of measuring serum Tn Ⅰ level to early disclose myocardium injury in patients with CO intoxication.

並列關鍵字

Troponin-Ⅰ ； Carbon monoxide intoxication ； Acute myocardial infarction