cTnI、Myo、CK-MB联合检测对急诊胸痛危险分层的价值

Value of Detecting Cardiac Troponin I,Myoglobin and Creatine Kinase Isoenzyme for Risk Stratification in Patients with Acute Chest Pain

目的探讨床边快速心肌肌钙蛋白I(cTnI)、肌红蛋白(Myo)和肌酸激酶同功酶(CK-MB)联合检测对急诊胸痛患者早期危险度分层的临床价值。方法采用美国博适-Triage干式快速定量心肌梗死/心衰诊断仪,对急诊的260例急性胸痛患者,采静脉血床边动态测定cTnI、Myo和CK-MB含量,并结合临床症状、心电图动态变化,对患者进行缺血风险评价,并随访cTnI阳性患者病死事件发生情况。结果 260例急性胸痛病例,首次危险分层高危组47例,中低危组213例,就诊后0h时点两组间cTnI和CK-MB含量具有显著性差异(P<0.05),Myo含量具有非常显著性差异(P<0.01)。基于心脏标志物变化的二次危险分层,确诊为AMI者106例,非AMI者154例。Myo、CK-MB、cTnI及三项联合诊断AMI的敏感性和特异性在胸痛发作后0～4h时间段分别是49.5%、60.0%;27.2%、92.6%;28.2%、100.0%;35.0%、84.2%;在4～8h时间段分别是70.7%、42.9%;68.3%、82.9%;75.6%、94.3%;71.5%、73.4%;在12h后分别是96.3%、36.7%;96.3%、73.3%;96.3%、86.7%;96.3%、65.6%。在短期随访期间(平均为28.5d),cTnI阳性和阴性患者的病死率分别为12.6%(13/103)和3.0%(4/134),P<0.005。结论床边快速cTnI、Myo和CK-MB联合检测,可提高对缺血性胸痛早期诊断的敏感性和特异性,有助于急性胸痛危险度分层与处理。

Objective To explore the value of bedside measurement of Cardiac Troponin I（cTnI）,Myoglobin（Myo）and MB isoenzyme of creatine kinase（CK-MB）for risk stratification in patients with acute chest pain.Methods The serum concentration of cTnI,Myo and CK-MB were determined in 260 patients with acute chest pain in the emergency department by using the Biosite Triage Meter Plus.At the same time,the clinical symptoms and the development of the ECG were analyzed,and the risk of myocardial ischemic was appraised,then the incidence of death in patients with cTnI positive were followed-up.Results At the first time of risk stratification,there were 47 patients in high danger group and 213 patients in middle or low danger group,and a significant difference in cTnI（P0.05）,CK-MB（P0.05）and Myo（P0.01）was observed.At the second time of risk stratification,there were 106 patients with confirmed acute myocardial infarction（AMI）and 154 patients without AMI;the sensitivity（Se）and specificity（Sp）of Myo,CK-MB and cTnI at 0-4 hours after acute chest pain outbreak were 49.5%,60.0% vs 27.2%,92.6% vs 28.2%,100% vs 35.0%,84.2%;at 4-8 hours were 70.7%,42.9% vs 68.3%,82.9% vs 75.6%,94.3% vs 71.5%,73.4%;after 12 hours were 96.3%,36.7% vs 96.3%,73.3% vs 96.3%,86.7% vs 96.3%,65.6%.The short-term followed-up（average 28.5days）showed that the death rate was 12.6%（13/103）in patients with positive cTnI and 3.0%（4/134）in patients with negative cTnI（P0.005）.Conclusion The bedside combined measurement of Myo,CK-Mb and cTnI can improve the sensitivity and specificity in the early diagnose of acute chest pain,and is helpful to the risk stratification and management.