三种心肌损伤标志物对急性心肌梗死的诊断效率评价

Efficiency of three kinds of myocardial injury markers in AMI diagnosis

目的 探讨心肌钙蛋白Ⅰ（cTnⅠ）、肌红蛋白（Myo）、肌酸激酶同工酶（CK-MB）单项和联合检测诊断急性心肌梗死（AMI）的敏感性和特异性。方法 分别采取患者发病后2、4、8小时静脉血，采用美国BECKMAN公司180SE ACCESS微粒子全自动化学发光分析仪及配套试剂，24h全天候开机，在1h内完成3项指标的检测。结果 在发病后2小时，只有Myo的敏感性达到45．36％。发病后4小时，Myo、cTnⅠ和CK-MB敏感性分别为89．81％、48．46％和53．92％。cTnⅠ＋Myo和cTnⅠ＋CK-MB的特异性分别为83．89％和85．27％。发病后8小时，cTnⅠ、Myo和CK-MB敏感性均达到100．00％，特异性从高到低依次为cTnⅠ＋Myo＋CK-MB（100．00％）〉cTnⅠ＋CK-MB〉cTnⅠ＋Myo〉Myo＋CK-MB〉cTnⅠ〉CK-MB〉Myo（76．35％）。结论 cTnⅠ、Myo、CK-MB单项和多项联合检测能很好地诊断AMI，但不同时间段各项指标的敏感性和特异性差别较大，临床应连续采血检测才能提高诊断率和制定最佳治疗方案。

Objective To investigate sensitivity and specificity of detection of cTnⅠ, Myo, and CK-MB in diagnosing acute myocardial infarction separately and in combination. Methods The venous blood samples from AMI patients were collected at different time-points（2, 4, 8 h） after heart attack. Three indexes （cTnⅠ, Myo, and CK-MB） detection was completed within one hour by means of a microsome full automatic chemiluminescence analyzer （180SE Access of American Beckman Company） and its relevant reagents. The analyzer kept on working for a whole day. Results At 2 h after attack, only the sensitivity of Myo reached 45.36%. At 4 h after attack the sensitivity of Myo, cTnⅠ and CK- MB reached 89.81%, 48.46% and 53.92% respectively. The specificity of cTnⅠ ＋ Myo and cTnⅠ ＋ CK-MB was 83.89% and 85.27% respectively. At 8 h after attack, the sensitivity of cTnⅠ, Myo and CK-MB all reached 100.00%, and the specificity in turn from high to low was cTnⅠ ＋ Myo ＋ CK- MB （100.00%）〉cTnⅠ ＋ CK-MB〉 cTnⅠ ＋ Myo〉 Myo ＋ CK-MB〉 cTnⅠ〉 CK-MB〉 Myo （76. 35%）. Conclusion AMI can be diagnosed effectively by both separated and combined examination with cTnⅠ, Myo, and CK-MB, but there is a significant difference of sensitivity and specificity in each index during different period of one hour, so only continuous blood-taking and examination can raise clinical diagnostic rate and establish a best therapeutic strategy.