血清cTnI、CK-MB和Mb浓度动态变化对急性心肌梗死的诊断价值

THE DIAGNOSTIC VALUE OF DYNAMIC CHANGES OF SERUM cTnI,CK-MB AND Mb IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

目的探讨血清心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）和肌红蛋白（Mb）浓度的动态变化对急性心肌梗死（AMI）的诊断价值。方法采用ELISA法检测了40例AMI病人不同时间血清cTnI、CK—MB和Mb浓度的变化，同时对血清cTnI、CKMB和Mb浓度进行了受试者工作特征曲线（ROC）分析。以40例健康查体者作对照。结果AMI病人胸痛发作后不同时间的血清cTnI、CK—MB浓度明显高于对照组（F=72．679、109．768，q=3．049～27．652，P〈0．01），且胸痛发作后不同时间浓度比较，差异有显著性（q=2．863～22．133，P〈0．05、0．01）；胸痛发作后3～6h、1d血清Mb浓度明显高于对照组、胸痛发作后3d和7d（F=17．729，q=6．175～8．688，P〈0．01）。且cTnI、CKMB对诊断AMI的灵敏度、特异度、准确度、约登指数、阳性预测值（PPV）和阴性预测值（NPV）明显高于Mb。AMI病人胸痛发作后3～6h血清CK—MB对诊断AMI的准确度高于cTnI和Mb，1d、3d血清CK—MB与cTnI诊断AMI的准确度相同，但优于Mb，而胸痛发作后7d时cTnI对AMI诊断的准确度明显优于CKMB。AMI病人胸痛发作后3～6h和1d时cTnI、CK—MB的AUC^ROC高于Mb，7d时cTnI的AUC^ROC高于CK—MB，且不同时间的cTnI和CKMB的AUC^ROC均大于0．9。结论血清cTnI、CK—MB和Mb浓度的动态变化对AMI具有明显的诊断价值和较高的准确度。

Objective To assess the value of dynamic changes of serum creatine kinase isoenzyme （CK-MB）, cardiac tro ponin I （cTnI）, and myoglobin （Mb） in the diagnosis of acute myocardial infarction （AMI）. Methods The serum cTnI, CK MB and Mb of 40 patients with AMI at different time were determined by enzyme-linked immunosorbent assay, 40 healthy subjects servered as controls. The serum cTnI, CK-MB and Mb were analyzed by receiver operating characteristic （ROC） curve. Results The serum cTnI, CK-MB and Mb concentration of AMI patients after the onset of chest pain at different time was higher than that of the controls（F=72.679,109.768;q =3. 049 27.652;P〈0.01）, and the difference of the concentrations at different time after chest pain was significant （q=2. 863- 22. 133;P〈0.05,0.01）. The serum Mb at 3-6 h after chest pain was significantly higher than that of after3andTdays（F= 17. 729,q= 6. 175- 8. 688,P〈0.01）. CK-Mb and cTnI were superior to Mb in the diagnosis of AMI in terms of sensitivity, specificity, accuracy, Yuedeng index, positive predictive value（PPV）and negative predictive value （NPV）. The diagnostic accuracy of serum CK MB was higher than cTnI and Mb after 3 to 6 h of chest pain. The diagnostic accuracy of serum cTnI and CK-MB of 1 and 3 days was same,but better than Mb. The accuracy of diagnosis of cTnI for AMI was better than CK MB at 7 days later of chest pain. The area under the ROC curve （AUC^ROC） of CK-MB and cTnI was higher than Mb, when chest pain onset after 3-6 h and 1 d. The AUC^ROC of cTnI was higher than CK-MB, when chest pain onset after 7 days. The AUC^ROC of CK-MB and cTnI was greater than 0.9. Conclusion The dynamic changes of concentration of CK-MB, cTnI and Mb are of obvious value and high accuracy in the diagnosis of AMI.