急性心肌梗死血清标志物的临床应用价值比较

COMPARISON OF CLINICAL VALUE OF SERUM MARKER WITH ACUTE MYOCARDIAL INFARCTION

目的比较急性心肌梗死(AMI)血清生化标志物的临床应用价值。方法用化学发光免疫分析法定量检测CK-MBⅡ、MYO、cTnI的含量,酶法测定AST、LDH、CK的活性。比较55例AMI、50例不稳定心绞痛(UA)、28例稳定心绞痛和30例陈旧性心肌梗死患者中以上项目动态变化并分析其特点及在AMI中的诊断意义。结果传统的心肌酶AST、CK、LDH在AMI早期(胸痛发生<6h)诊断敏感性明显低于MYO(p<0.01),所以AMI的早期诊断指标推荐MYO;胸痛发生6～12h,cTnI、CK-MB、MYO的敏感性均高于AST、CK、LDH(p<0.01);12～24h,cTnII、CK-MB则显示出诊断上的优势;48h～7d则cTnI诊断敏感性强于其他各项(p<0.01)。在AMI诊断特异性上,cTnI与CK-MBⅡ相当,优于MYO、CK、AST、LDH(p<0.05)。在介入治疗中,CK-MBⅡ、MYO、cTnI均可反映心肌的损伤,其中以cTnI反映最敏感。结论对AMI的诊断,cTnI、CK-MBⅡ、MYO优于AST、LDH、CK,MYO不升高可排除早期AMI,cTnI能反映心肌的微小损伤,CK-MBⅡ、MYO、eTnI3项指标相互补充对诊断AMI有重要临床价值。

Objective To evaluate the clinical value of serum maxker of acute myocardial infarction（AMI）. Methods ＂Ihc content of CK - MB Ⅱ ,MYO and cTnl were determined by using auto - immuno - chemistry luminescence method, the activation of AST,LDH and CK were determined by using enzymatic method. 55 eases of AMI,50 cases of unstable angina（UA） ,30 cases of old myocardial in -faxcfion and 28 cases of stable angina were observed. Changes of serum CK - MB Ⅱ, MYO, cTnl, AST, LDH and CK were detected in different stages. The clinical Values of such 5enlln markers in diagnosis AMI wrer compared each other. Results The highest sensitivity of serum MYO was wthin 6h after the Onset of chest pain in AMI patients. The sensitivity of MYO matched with that of cTnI. CK - MB II was during 6 - 12h ,but higher than that of AST - LDH and CK - The superiority of diagnosis of eTM and CK - MB Ⅱ was outstanding during 12 - 24h. The sensitivity of rum eTnl was the highest during 6h. The specificity of eTnI matched with that of CK - MB Ⅱ, but was better than that of MYO - CK, AST and LDH. Conclusion If the level of MYO was not increase - early AMI could be eliminated, Both eTM and CK - MB Ⅱ,MYO would be good markel＇s for diagnosis AMI.