心肌损伤标记物在急性心肌梗死早期诊断中的临床意义

Comparative Study of New Myocardial Injury Marker in Early Diagnosis of Acute Myocardial Infarction

目的:探讨新的生化标记物对急性心肌梗死(AM I)早期诊断价值。方法:动态监测198例AM I患者血清心肌肌钙蛋白I、T(cTnI、cTnT)及肌酸磷酸激酶(CK)及同工酶(CK-MB)的变化,对比分析它们对AM I的早期诊断和预后的判断价值。结果:AM I起病6小时之内,以cTnI诊断敏感性最高(90.20%),CK-MB次之(52.94%),CK最低(27.45%);cTnI和cTnT升高程度及持续时间与预后呈正相关。结论:早期确诊或排除AM I以cTnI和CK-MB组合更为可取;判断溶栓是否再通,cTnI和CK-MB更为准确可靠;这些心肌损伤标记物升高显著并呈持续升高者,则提示预后不佳。

Objective： This study was designed to evaluate whether a new marker are the better choice for patients with early acute myocardial infarction（AMI）. Methods：Serial serum concentrations of cTnl. cTnT, creatine kinase（CK） and CK- MB were measured in 198 patients with established AMI. Their diagnostic and prognostic values for AMI were comparatively analyzed. Results： The diagnostic accuracy of cTnl or cTnT, CK- MB and CK was 90.20% ,52.94% and 27.45% respectively within 6 hours after the onset of chest pain. Five patients,who had higher and longer serum cTnl and cTnT values,died from cardiac shock and sudden death. Other four patient with higher serum cTnI and cTnT died during a follow - up period. Conclusions ： cTnl or cTnT is a better marker for the diagonsis of AMI. cTnl or cTnT and CK - MB are reliable for the prediction of coronary artery reperfusion .after thrombolytic therapy. Long lasting and significantly high level of cTnl and cTnT may be the indicators of poor prognosis.