[논문]Seuil de positivité de la troponine i cardiaque dans le diagnostic de l’IDM péri-opératoire après chirurgie cardiaque sous circulation extra-corporelle chez l’adulte

Biaz, Asmâ; a; Drissi, Mohammed; Maataoui, Aissam El; Idrissi, Samira El Machtani; Bouhsain, Sanae; Dami1, Abdellah; Boulahya, Abdellatif; Ouzzif, Zohra

doi:10.11604/pamj.2018.29.40.12900

[해외논문] Seuil de positivité de la troponine i cardiaque dans le diagnostic de l’IDM péri-opératoire après chirurgie cardiaque sous circulation extra-corporelle chez l’adulte
Positivity threshold value for cardiac troponin lc in the diagnosis of perioperative myocardial infarction after on-pump cardiac surgery in adult patients 원문보기

The Pan African medical journal, v.29, 2018년, pp.40 -

Biaz, Asmâa (Service de Biochimie, Toxicologie Hô) , Drissi, Mohammed (pital Militaire d’Instruction Mohammed V Rabat, Maroc) , Maataoui, Aissam El (Service de Chirurgie Cardio-Vasculaire Hô) , Idrissi, Samira El Machtani (pital Militaire d’Instruction Mohammed V Rabat Maroc) , Bouhsain, Sanae (Université) , Dami1, Abdellah (Ibn Zohr, Faculté) , Boulahya, Abdellatif (de Mé) , Ouzzif, Zohra (decine et de Pharmacie d’Agadir, Dé)

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IntroductionThis prospective study was conducted at the Laboratoy of Biochemistry of the HMIMV, Rabat, over a period of 1 year. It aimed to analyse the kinetics of troponin lc (cTnl) after on-pump cardiac surgery in order to establish threshold values for the diagnosis of perioperative myocardial infarction.MethodsThe study included 58 patients who had undergone on-pump valvular surgery or on-pump coronary artery bypass surgery. These patients were separated into 3 groups according to their clinical and electrical evolution as well as their laboratory tests (cTnI) during the immediate post-operative period. We batched and followed the kinetics of cTnl using immuno-enzymatic technique, CTNI Flex® reagent, before and after on-pump cardiac surgery, at H0, H3, H6, H12, H21, H24 and H72 using automatic SIEMENS Dimension Xpand Plus.ResultsThe results were higher than in cardiology, even among the group of patients without postoperative cardiac complications, with an average cTnl rate of approximately 2.5 times higher than the threshold value in cardiology. The kinetics of release differed significantly among the 3 groups (p‹ 0.05).ConclusionThe threshold value that we propose to confirm the diagnosis of perioperative myocardial infarction is 13ng/ml obtained between H12 and H24. We recommend to collect 1-2 samples at H12 and then between H20 and H24.

Abstract

IntroductionL'objectif de cette étude prospective, réalisée sur une année au laboratoire de biochimie de l'HMIMV de Rabat, vise à étudier la cinétique de la Troponine Ic (TnIc) après chirurgie cardiaque sous circulation extracorporelle (CEC) en vue d'établir des valeurs seuils pour le diagnostic d'infarctus de myocarde péri-opératoire (IDMPO).MéthodesNous avons inclus 58 patients opérés pour chirurgie valvulaire ou pontage coronarien sous CEC. Ces patients ont été séparés en 3 groupes selon l'évolution clinique, biologique (TnIc) et électrique durant la période post opératoire précoce. Nous avons dosé et suivi la cinétique de la TnIc par une technique immuno-enzymatique, au moyen du réactif FlexR CTNI avant et après la CEC, à H0, H3, H6, H12, H21, H24 et H72 sur l'automate Dimension Xpand plusR de la société Siemens.RésultatsLes résultats obtenus sont plus élevés qu'en cardiologie, même chez le groupe des patients sans complications cardiaques post opératoires, avec un taux moyen de TnIc environ 2,5 fois supérieur à la valeur seuil en cardiologie. La cinétique de libération est significativement différente entre les 3 groupes (p‹0,05).ConclusionLa valeur seuil que nous proposons pour confirmer le diagnostic de l'IDMPO est de 13ng/ml obtenue entre H12 et H24. Nous recommandons, de ce fait, un à deux prélèvements vers H12 puis entre H20 et H24.

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참고문헌 (10)

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