肌红蛋白在急性冠状动脉综合征诊断和治疗中的应用价值

The clinical value of measuring plasma myoglobin in diagnosis and therapy of acute coronary syndrome

目的探讨肌红蛋白(MYO)检测在急性冠状动脉综合征(ACS)发病早期诊断和溶栓再通效果监测的应用价值。方法应用免疫比浊法检测胸痛患者入院即刻血浆中的MYO、肌钙蛋白T(cTnT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)含量并比较其在不同时点的敏感度、特异度、阳性预测值、阴性预测值。对实施冠状动脉造影的病例观察其冠状动脉病变的严重程度与MYO的相关性。观察MYO在溶栓前后的变化。结果入院即刻心梗组的MYO、cTnT、CK、CK-MB分别为(56±34)μg/L,(0．05±0．03)μg／L,(94±84)U／L,(17±13)U／L,均高于健康对照组(P<0．05),并且Q波心梗组(263±182)μg／L明显高于非Q波心梗组(165±102)μg／L,P<0．01。不稳定性心绞痛组的MYO(56．48±33．59)μg／L高于健康对照组(P<0．01),不稳定性心绞痛组CK、CK-MB与健康对照组比较差异无统计学意义(P>0．05)。MYO在胸痛发作8 h时敏感度最高,特异度在发病24 h内高于cTnT(P<0．01),与CK-MB差异无统计学意义(P>0．05)。MYO和CK-MB的阳性预测值在发病24 h内均高于cTnT,阴性预测值在4 h MYO高于cTnT和CK-MB(P<0．01)。冠状动脉造影多支病变组的MYO含量(167±72)μg／L高于单支和早期病变组(P<0．01),早期病变组与单支组差异无统计学意义(P>0．05)。MYO在溶栓术后在血浆中含量明显升高,酶峰出现在5．26 h,比CK、CK-MB明显提前(P<0．01)。结论MYO是一个灵敏、可靠的早期诊断ACS和监测溶栓疗效的指标,联合CK、CK-MB、cTnT测定更有意义。

Objective To explore the clinical value of measuring myoglobin （ MYO ） for the early diagnosis of ACS and monitoring the effect of thrombolysis. Methods MYO and cTnT, CK, CK-MB were measured. The sensitivity, specificity, positive predicting value and negative predicting value of cTnT and CK-MB at different time points were studied. And the correlation was investigated between the MYO plasma level and the severity of coronary artery lesion according to coronary arteriongraphy. The changes of MYO level with thrombolysis were also observed. Results The concentration of MYO, cTnT, CK, CK-MB in acute myocardial infarction patients were （56 ±34） μg/L, （0. 05 ±0. 03） μg/L, （94 ±84） U/L, （ 17 ± 13） U/L respectively, which were higher than that in the healthy controls（ P 〈 0. 05 ）. The level of them in QMI group were（263 ± 182） μg/L higher than that in NQMI group （ 165 ± 102 ） μg/L, P 〈 0. 01. The level of MYO（56 ±34）μg/L was higher in UAP group when comparing with healthy controls（ P 〈0. 01 ）. MYO is most sensitive at 8 hours from the beginning of onset, and more specific than cTnT within 24 hours. The PPVs of MYO and CK-MB were higher than that of cTnT in 24 hours after chest pain occurring. The NPV of MYO at 4 hours was higher than that of cTnT and CK-MB （ P 〈 0. 01 ）. The level of MYO in multi-vessel group was[ （ 167 ± 72 ）μg/L] higher than that of single vessel group and premature group （ P 〈 0. 01 ）, but there was no difference between premature group and single vessel group （ P 〉 0. 05 ）. The level of MYO rises to the peak at 5.26 hours after operating thrombolysis. The peak time was earlier than CK and CK-MB （ P 〈 0.01 ）. Conclusions The MYO is a sensitive and reliable criterion for early diagnosis of ACS, and can also reflect the effect of thrombolysis. It can be more significant combining the CK, CK-MB and cTnT.