急诊室胸痛患者血清心肌钙蛋白Ⅰ检测结果的临床分析

The cTNI value and its Applicability for Chest Pain Patients in Emergency Room

目的评价急诊胸痛患者血清心肌钙蛋白Ⅰ(cTNI)水平并探讨其与急性心肌梗死的诊断关系。方法对来我院急诊室就诊的胸痛患者的cTNI进行检测并按其轻重程度进行分组分析临床资料,评价急诊患者血清cTNI水平与急性心肌梗死诊断及其伴随疾病的关系。结果胸痛患者297例人选分析,其中血清cTNI值轻度增高组(0.04～0.1 ng/d1)52例、中度增高组(0.1～1 ng/dl)72例及明显增高绀(1～10.0 ng/dl)67例,极高组(>10 ng/dl)10例,以及正常值对照组(<0.04 ng/dl )96例。通过对急诊胸痛患者血清cTNI,肌酸激酶(CK),肌酸激酶同工酶(CKMB),谷草转氨酶(GOT),乳酸脱氢酶浓度(LDH)与急性心肌梗死的ROC曲线分析,对诊断急性心肌梗死的敏感性和特异性,血清cTNI大于总CK和AST,且高于CKMB和LDH,当cTNI为0.107 ng/dl时,其灵敏度和特异度最高,分别为80.5%和73.2%;冠心病组自胸痛发作至测定血清cTNI高点的平均时间为19 h (10.8～26.0 h)。冠心病患者占73.7%,其中急性心肌梗死占53.9%,心绞痛占39.7%。冠心病组与非冠心病比较,冠心病组糖尿病,高血脂,年龄血清cTNI水平均增高明显;非冠心病组风心病cTNI水平明显高于冠心病组。高血压,颈椎病,肾功能不伞,脑梗塞冠心病组与非冠心病比较无差异。结论冠心病是我院急诊室胸痛的主要构成,占73.7%,其中急性心肌梗死占53.9%。血清cTNI测定对急性心肌梗死诊断的敏感性和特异性高于心肌酶学测定,以血清cTNI浓度0.107 ng/dl时,其敏感性和特异性最高。

Objective To evaluate the cTNI value of chest pain patients and its sensitivity and specificity for acute myocardial infarction diagnoses in emergency room, Methods To analysis the clinical data of chest pain patients in our emergency room,that had been test the cTNI,myocardial enzymes（ CK, CKMB, LDH, GOT） , qualified history recording, as well as definitely diagnoses, and then analyzed the relation between cTNI value and acute myocardial infarction （AMI）, and company diseases, such as hypertension, dyslipidemia ,diabetes mellitus ,renal function failure , rheumatic heart disease （RHD）, and stroke, Results There were 297 patients were enrolled, that 52 pts in group 1 （ cTNI 0, 04 - 0.1 ng/dl）, 72 pts in group 2 （0, 1 -1 ng/dl）, 67 pts in group3 （1 -10.0 ng/dl）, 10 pts in group 4 （ 〉 10 ng/dl）, as well as the 96 pts with normal range cTNI（ 〈 0.04 ng/dl ）in group 5. According to its ROC curve,both sensitivity and specificity of cTNI for AMI diagnoses was the greater than creatine kinase, creatine kinase MB, lactae dehydrogenase and serum glutamic-oxaloacetic transaminase （ SGOT ） （ aspartate aminotransferase, AST ） , its optimal cut-off point was 0, 107ng/ml, and its sensitivity and specificity was 80, 5% and 73.2% respectively; the duration time from pain setup to the blood sample took was 19 hrs（ 10 -28.5 hrs）. 73.7% of patients were coronary heart diseases（ CHD）, and 53.9% were acute myocardial infarction among CHD ,angina pectoris were 39.7%. Comparisons between CHD and no CHD group, DM, dyslipidemia, age were higher significantly in CHD group than no CHD, and otherwise RHD were higher significantly in no CHD group. Neither of hypertension, diabetes mellitus, dyslipidemia, cervical spondylosis,renal function failure and celebrates vascular diseases had signficandy difference between groups. Conclusion The coronary heart disease were the main part of chest pain patients in emergence room, and its percent were 73.7 and among it 53.9% were acute myocardial infarction. The sensitivity and specificity of cTNI test for AMI diagnoses is the highest than other cardiac enzymes , and its sensitivity and specificity was 80.5% and 73.2% as its cut-off point was 0. 107 ng/dl.