床旁定量心脏标志物检测的前瞻性研究

A prospective study evaluating the diagnostic value of quantitative bedside-testing of cardiac marker

目的 床旁定量检测心脏标志物与中心实验室检测的相关性,探讨床旁心脏标志物尤其肌钙蛋白诊断心肌坏死或心肌损伤的价值。方法 连续收入院的123例心内科住院患者,其中17例诊断为ST段抬高心肌梗死患者,56例诊断为非ST段抬高急性冠状动脉综合征患者,另外50例为其他心脏病患者。入院后即刻采血,标本同时送中心实验室和行床旁检测,观察两种检测方法各标志物的相关性,和床旁肌钙蛋白Ⅰ(TnI)诊断非ST段抬高急性冠状动脉综合征的价值。结果 在冠心病患者床旁定量检测的TnI、肌红蛋白(MYO)和肌酸激酶-同工酶(CK-MB)与中心实验室测定结果相关性良好。在ST段抬高心肌梗死患者,TnI床旁与中心实验室检查的结果符合率为:100％,而在非ST段抬高急性冠状动脉综合征患者,其敏感性不高(68.2％),但特异性接近100％。结论 床旁定量检测TnI对于ST段抬高心肌梗死患者的诊断与临床和中心实验室完全符合,但在非ST段抬高急性冠状动脉综合征患者,床旁定量检测敏感性不及中心实验室,不宜用于危险分层或者非ST段抬高心肌梗死的诊断。

Objective To observe the correlation of cardiac marker measurement at bedside and at central-lab, and to determine the value of bedside-testing for the diagnosis of myocardial necrosis or injury. Methods Consecutive 123 cases of patients were included, 17 of them were ST elevation myocardial infarction, 56 of them were non-ST elevation acute coronary syndrome, and 50 of them were patients with other heart disease. Blood sampling were initiated after admission for bedside and central-lab determinations of cardiac marker. Results The results of quantitative bedside testing were closely related to that of central-lab. It was comsistent between the results of bedside-testing and central-lab in patients with ST elevation myocardial infarction. In patients with non-ST elevation acute coronary syndrome, the sensitivity of bedside-testing was lower than central-lab testing, but the specificity was nearly 100%. Conclusions It is shown that the correlation of cardiac marker determination between quantitative bedside testing ( Biosite Diagnostics, Triage ) and central-lab testing is good. It is similar between two kinds of testing for the diagnosis of ST elevation myocardial infarction, but it is not sensitive enough for risk stratification and for the defining of non-ST elevation myocardial infarction, though the specificity is high.