几种心肌损伤标志物对急性心肌梗死的诊断效率

Efficiency of myocardial injury markers in AMI diagnosis

目的研究肌钙蛋白Ⅰ(TnI)、肌红蛋白(Myo)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CKMB)、高敏感C-反应蛋白(hsCRP)等心肌标志物在急性心肌梗死(AMI)的诊断效率。方法AMI病人66例、心绞痛病人64例,TnI和Myo测定用化学发光法,仪器为ACCESS;CK、CKMB等用酶动力连续监测法、hsCRP用增强胶乳免疫浊度法,仪器为HITACH7060全自动生化分析仪。结果诊断AMI的敏感性和特异性分别为:TnI>0.05μg/L为96.96%和45.31%、TnI>0.5μg/L为84.45%和87.50%、Myo>70.00μg/L为93.99%和64.10%、Myo>100.00μg/L为90.91%和73.43%、CK>200 U/L为81.82%和84.38%、CKMB>20 U/L为81.82%和73.44%,HsCRP>3.0 mg/L为93.75和26.00%、HsCRP>6.0 mg/L为88.24%和40.00%;联合诊断的敏感性和特异性分别为:cTnI>0.05μg/L+Myo>70.00μg/L为90.91%和89.10%,cTnI>0.5μg/L+Myo>100.00μg/L为75.75%和100.00%,CK>200U/L+CKMB>20 U/L为72.72%和89.06%。结论TnI>0.5 ng/L+Myo>100 ng/L可以单独确诊,尽管心电图没有Q波;TnI>0.5 ng/L或Myo>100 ng/L,即使缺乏其它支持指标,也可以按AMI进行诊断和治疗;TnI<0.05ng/L+Myo<70 ng/L排除AMI的可能性较大;CK、CKMB、AST、LDH、HBDH仍有一定的鉴别诊断价值。

Objective To study the diagnostic efficiency of common myocardial markers： TnI, Myo, CK, CKMB and hs-CRP, both separately and in combination.Methods The myocardial markers were qualified and compared with each other in AMI patients（ n = 66） and angina patients（ n = 64）. Results The sensitivity and specificity of AMI diagnosis is 96.96% and 45.31% when using TnⅠ 〉 0.05μg/L;84.45% and 87.50% when TnⅠ 〉 0.5μg/L;93.99% and 64.10% when Myo 〉 70.00 μg/L;90.91% and 73.43% when Myo〉 100.00μg/L;81.82% and 84.38% when CK 〉 200 U/L;81.82% and 73.44% when CKMB〉 20 U/L;93.75% and 26.00% when HsCRP〉 3.0 mg/L;88.24% and 40.00% when HsCRP〉 6.0 mg/L;90.91% and 89.10% when cTnⅠ 〉 0.05μg/L combined with Myo 〉 70. 00μg/L;75.75% and 100.00% when cTnⅠ 〉 0.5μg/L combined with Myo〉 100.00μg/L;72.72% and 89.06% when CK 〉 200 U/L combined with CKMB 〉 20 U/L.Conclusion TnⅠ 〉 0.5 ng/L combined with Myo 〉 100 ng/L help to diagnosis AMI definitely,either Q wave appears in ECG or not. TnⅠ 〉 0.5 ng/L or Myo 〉 100 ng/L support the diagnosis and clinical treatment of AMI. Patients with TnⅠ〈 0.05 ng/L combined with Myo〈 70 ng/L could hardly be diagnosed as AMI. Traditional marker： CK,CKMB,AST, LDH and HBDH still have significancy in differential diagnosis of AMI and angina poctoris.