生化标志物联合检测在缺血性心肌损害中的诊断价值

Clinical diagnotic value of combined detection of biochemical markers in myocardial ischemic injury

目的探讨生化标志物:缺血修饰清蛋白(IMA)、肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(CTnI)联合检测对缺血性心肌损害的早期诊断价值。方法选择因急性胸痛来本院就诊的患者95例,在胸痛≤1 h、3 h、6 h、12 h、24 h连续监测IMA、Mb、CK-MB、CTnI 4项指标,观察其在疾病过程中的变化规律。结果有典型心肌梗死心电图变化组入院:在胸痛≤1 h IMA、Mb、CK-MB、CTnI敏感性分别为81.0%、38.1%、28.5%、14.2%,IMA敏感性与其他3项相比差异均有统计学意义(P<0.05)。在胸痛≤3 h时IMA、Mb、CK-MB和CTnI4项指标联合检测敏感性为95.3%,均高于单项检测,差异有统计学意义(P<0.05)。结论在缺血性心肌损害的早期,IMA是一个比较灵敏的指标,IMA、Mb、CK-MB、CTnI联合检测诊断缺血性心脏病,明显提高了检测的灵敏度,具有较高的临床实用价值。

Objective To investigate the early diagnostic value of combined detection value of biochemical markers including ischemia modified album （IMA）, myohemoglobin （Mb）, creatine kinase isozyme （CK-MB） and cardiac tropnin I （cTnI） in myocardial ischemic injury. Methods Ninety-five patients with acute chest pain were enrolled in the investigation. Four biochemical markers （IMA, Mb, CK-MB and cTnI） were monitored continually at different time-points （1, 3, 6, 12 and 24 h after chest pain onset）. The law of the parameters dynastic changes was investigated in the course. Results In the group of typical varying electrocardiograph, the sensitivity was 81.0% for IMA, 38.1% for Mb, 28.5% for CK-MB and 14.2% for cTnI at 1 h time-point. Its sensitivity of IMA was remarkable different from the other three groups （P〈0.05）. The sensitivity of combined detection of IMA, Mb, CK-MB and cTnI was 95.3%, much higher than any single detection at 3 h time-point （P〈0.05）. Conclusion IMA is an early and sensitive marker for myocardial ischemic injury. Combined detection of IMA, Mb, CK-MB and cTnI significantly enhances sensitivity and has a high practical clinical value.