心肌肌钙蛋白I与几种常用急性心肌梗死诊断标志物临床应用价值的比较研究

Clinical comparison of cardiac troponin I and cardiac markers for diagnosing acute myocardial infarction

目的：比较心肌肌钙蛋白Ｉ（ｃＴｎＩ）与几种常用的急性心肌梗死（ＡＭＩ）诊断标志物的临床应用价值。方法：采用３８例ＡＭＩ和４４例非心肌梗死之心绞痛（ＡＰ）患者的同一血样本，同时检测心肌ｃＴｎＩ、肌酸激酶（ＣＫ）、肌酸激酶同工酶（ＣＫＭＢ）、乳酸脱氢酶（ＬＤＨ）、天冬氨酸转氨酶（ＡＳＴ）和α羟丁酸脱氢酶（αＨＢＤ）等６项指标，然后进行２组间比较。并分别对ＡＭＩ组和ＡＰ组各指标间的差异作对比分析。结果：ｃＴｎＩ对急性心肌梗死的诊断灵敏度高于ＣＫ、ＣＫＭＢ、ＬＤＨ、ＡＳＴ和αＨＢＤ（分别为阳性率９４．７％、５５．３％、６３．２％、７１．１％、６８．４％和６５．８％），Ｐ＜０．０１；ｃＴｎＩ特异性与ＣＫ、ＣＫＭＢ和αＨＢＤ相当（阴性率分别为９５．５％、８８．６％、８６．３％和８４．１％），Ｐ＞０．０５，而高于ＬＤＨ、ＡＳＴ（阴性率分别为９５．５％、７９．６％和７２．７％），Ｐ＜０．０５。结论：心肌肌钙蛋白Ｉ对于ＡＭＩ的诊断具有较高灵敏度和较强特异性，是一种心肌损伤的特异性标志物。

Objective:To compare the clinical diagnostic value of cardiac troponin I (cTnI) and creatine kinase (CK),creatine kinase MB (CKMB),aspartic transaminase (AST),lactic dehydrogenase (LDH) and αhydroxybutyric dehydrogenase (αHBD) in patients with acute myocardial infarction (AMI) or angina pectoris (AP).Methods:The serum or plasma cTnI,CK,CKMB,LDH,AST and αHBD levels were simultaneously measured in 38 patients with AMI and 44 patients with AP.In all patients tests were performed at 3￣48 hours after the onset of chest pain symptom.Results:The sensitivity of cTnI for diagnosis of AMI was 94 7%,which was significantly higher than that of CK,CKMB,LDH,AST and αHBD (55 3%,63 2%,71 1%,68 4%,65 8%,respectively, P <0 01).Moreover,a specificity of cTnI was 95 5%,which was similar to CK,CKMB as well as αHBD(88 6%,86 3%,and 84 1%,respectively, P >0 05),while remarkably higher than LDH and AST (79 6% and 72 7% respectively, P <0 05).Conclusions:Cardiac troponin I,which served as a useful cardiac damage marker,is superior to other cardiac markers for diagnosing AMI.