肌钙蛋白Ⅰ在急性心力衰竭鉴别诊断中的应用价值

The Diagnostic Value of Serum Cardiac Troponin Ⅰ in Acute Heart Failure

目的:明确肌钙蛋白Ⅰ(cTnI)在心源性呼吸困难的鉴别诊断中有无应用价值。方法:比较急性心衰与急性肺源性呼吸困难时cTnI的变化情况,并观察一定的cTnI临界值辅助诊断心衰的敏感性和特异性。结果:总共156例患者,最后确诊为急性心衰的患者69例,而肺源性呼吸困难患者87例。急性心衰组的平均cTnI值为0.76±0.85ng/dL,而肺源性呼吸困难组为0.25±0.32ng/dL,两组间有显著性差异(P<0.001)。根据ROC曲线计算肌钙蛋白Ⅰ的临界值(截点值)为0.42ng/dL,其鉴别心衰的敏感度为71.53%,特异度为90.36%,准确度为80.14%。结论:检测肌钙蛋白Ⅰ水平并与其它临床信息相结合,有助于快速准确地诊断充血性心力衰竭。

Objective： The goal of this study is to investigate the value of serum cardiac troponin Ⅰ （cTnI） as a diagnostic and differential-diagnosis method in acute heart failure. Methods： We conducted a prospective study of 156 patients who came to the emergency department with acute dyspnea and whose cardiac troponin I was measured. The clinical diagnosis of congestive heart failure was adjudicated by two independent cardiologists, who were blinded to the results of the serum cardiac troponin Ⅰ assay. Results： Sixty-nine patients were diagnosised as acute congestive heart failure, while eighty-seven patients were noncardiac（pneumonic） causes. The cTnI levels of patients with a diagnosis of acute congestive heart failure was 0.76±0.85 ng per decilitre, whereas those without congestive heart failure was 0.25±0.32 ng per decilitre. The difference among groups was significant （P〈0. 001）. A cardiac troponin Ⅰ cutoff value of 0. 42 ng per decilitre had a sensitivity of 71.53 percent, a specificity of 90. 36 percent, and an accuracy of 80. 14 percent for differentiating acute congestive heart failure from other causes of dyspnea. Conclusion： Combined with other clinical information, rapid measurement of cardiac troponin I is a kind of useful tool in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea.