心肌肌钙蛋白Ⅰ在急性心肌梗塞的早期诊断中的价值及其动态变化

Dynamic observation and early diagnosis value of cardiac troponin Ⅰin patients with acute myocardial infaretion

目的探讨心肌肌钙蛋白Ⅰ(cTnl)对急性心肌梗死(AMI)的早期诊断价值及其动态变化。方法同时测定入院患者血清的cTnl、谷草转氨酶(AST)、肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶MB(CK—MB)、乳酸脱氢酶(LDH)和α—羟丁酸脱氢酶(HBDH)等6项指标,并统计出阳性率和被确诊为AMI的人数,然后比较其敏感性、特异性和准确性。并观察AMI病人cTnl阳性持续时间。结果敏感性、特异性和准确性分别为cTnl(86.2%,83.2%,84.19%)、AST(78.7%,69.4%,76.1%)、CK(?80.8%,70.8%,74.3%)、CK—MB(80.8%,71,91%,75.0%)、LDH(75.5%,57.87%,64.0%)和α—HBDH(68.1%,73.0%,71.32%),cTnl对急性心肌梗死的诊断敏感性与AST、CK、CK—MB、LDH无显著性差异(P>0.05),与HBDH有显著性差异(P<0.05);cTnl的特异性和准确性与AST、CK、CK—MB、LDH、HBDH有显著性差异,(P<0.05～0.01);观察AMI病人cTnl阳性持续时间,可达5天。结论在诊断AMI时,cTnl具有简便快速,出现时间早,灵敏度、特异性和准确性高,诊断窗口时间长等优点,对AMI的早期诊断具有较好的价值,适用于床边检验(POCT)、快速诊断。

Objective To evaluate the dynamic observation and early diagnosis value cTnl in early diagnose acute myocardial infarction. Methods The serum cTnl, AST,CK,CK-MB, LDH, α-HBDH density were measured in patients of coming into the hospital. Meanwhile, Count the positive rate of cTnl, AST, CK, CK-MB, LDH, α-HBDH and AMI sufferers having been diagnosed. Then, To compare their sensitivity, distinguish ability, veracity. To observe the durative time of positive cTnl in AMI patients. Results Sensitivity, distinguish ability, veracity are cTnl(86.2%, 83.2%, 84.19%)?AST(78.7%,69.4%,76.1%)?CK(?芽80.8%,70.8%,74.3%)?CK-MB(80.8%,71,91%,75.0%)?LDH(75.5%,57.87%,64.0%)andα-HBDH(68.1%,73.0%,74.3%). The sensitivity of cTnl for diagnosis of AMI, which was unremarkable difference for AST, CK, CK-MK, LDH, while was remarkable difference for HBDH. The distinguish ability and veracity of cTnl are higher than AST, CK, CK-MB, LDH, α-HBDH, there were remarkable difference for the results. The time of positive cTnl in AMI patients last five days. Conclusions cTnl have the better value in early diagnosing AMI. Such as convenient and high-speed, early produce, higher sensitivity and distinguish ability and veracity and longer diagnosis time window. It adapts to fast diagnosis in point-of-care testing (POCT).