心肌损伤标志物在非Q波型急性心肌梗死早期诊断中的应用

Clinical value of markers for myocardial damage in the early diagnosis of non-Q wave acute myocardial infarction

目的探讨心肌损伤标志物在非Q波型急性心肌梗死（AMI）早期诊断中的应用，减少非Q波型AMI误诊的机会。方法通过单克隆金标志双抗免疫渗滤快速分析法，动态观测心肌标志物在非Q波型AMI时的敏感性、特异性、漏诊率及诊断符合率。结果心肌肌钙蛋白I（cTnI）、肌红蛋白（Myo）、肌酸激酶-同工酶质量（CK-MB mass）对非Q波型AMI的相对敏感性为38．3％～85．1％，诊断符合率为62．1％～82．8％，均随时间增加逐渐增高；相对特异性为75．0％～100％，漏诊率为14．9％～61．7％，均随时间增加降低；心肌肌钙蛋白T（cTnT）、cTnI在不同时间均优于CK-MB mass，Myo相对敏感性在6h后迅速从85．1％下降至44．7％、12．8％，漏诊率在6h只有14．9％。结论cTnT、cTnI、Myo、CK-MBmass对非Q波型AMI的早期、快速诊断具有一定价值，其临床应用将减少非Q波型AMI误诊的机会。

Objective To explore the clinical value of markers for myocardial damage in the early diagnosis of non-Q wave acute myocardial infarction, so as to reduce the opportunity of misdiagnosis. Methods Monoclone goldlabeled double antibodies rapid immunofiltration assay was applied to monitoring the sensitivity, specificity, rate of missed diagnosis and diagnose accordance rate of markers for myocardial damage in the early diagnosis of non-Q wave acute myocardial infarction. Results The relative sensitivity of cardiac troponin I（cTnI）, myoglobin（Myo） ,creatine kinase（CK）,CK-MB isoenzyme mass was 38.3 %-85.1% in non-Q wave acute myocardial infarction, and the diag- nose accordance rate was 62.1%-82.8%, both increased gradually along with the time; while the relative specificity was 75.0%-100%, rate of missed diagnosis was 14.9%-61.7%, both decreased gradually along with the time. Cardiac troponin T（cTnT） and cTnI were superior to CK-MB mass at different time-points. The relative sensitivity of Myo after 6 h dropped rapidly from 85.1% to 44.7% and 12.8%, while its rate of missed diagnosis at 6 h time-point was only 14.9%. Conclusion cTnT, cTnh Myo and CK-MB mass contributes to the early and rapid diagnosis of non Q wave acute myocardial infarction. Their clinical application may reduce the misdiagnosed opportunity of non-Q wave acute myocardial infarction.