肌钙蛋白I、肌酸激酶同工酶和钠尿肽联合检测在急性心肌梗死早期诊断中的应用

Application of early diagnosis of acute myocardial infarction detected with cardiac troponinⅠcombined with CK-MB and B-type natriuretic peptide

目的探讨肌钙蛋白(IcTnI)、肌酸肌酶同工酶(CK-MB)和钠尿肽(BNP)联合检测在急性心肌梗死(AMI)早期诊断中的应用。方法收集胸痛发作3h以内的急诊患者126例,按AMI诊断标准分为急性心肌梗死组(AMI组)和非急性心肌梗死组。采用Judkins法,以6F冠状动脉造影导管经右股动脉途径进行冠状动脉造影,并对确诊患者进行冠状动脉介入治疗(PCI)。对126例患者定时采集静脉血,定量检测cTnI、CK-MB、BNP的浓度。对结果进行统计学分析。结果 AMI组与非AMI组患者之间基本临床资料差异无统计学意义。患病各时间段检测结果显示,AMI组患者血清cTnI、CK-MB和BNP含量均明显高于非AMI组(P<0.05)。联合检测cTnI、CK-MB和BNP对AMI诊断的敏感度为98.3%,特异性为89.0%,与分别单独检测cTnI、CK-MB和BNP的敏感度和特异性(分别为87.0%、82.2%、85.5%;79.6%、75.0%、73.4%)比较明显增高(P<0.05)。结论联合检测cTnI、CK-MB和BNP,可明显提高AMI早期诊断的敏感度和特异性,与冠状动脉造影结果高度一致。

【Objective】To investigate the clinical application of cardiac troponinⅠ,CK-MB and BNP detected together for early diagnosis of acute myocardial infarction.【Methods】126 emergency cases with chest pain less-than 3 hours were divided into AMI group and non-AMI group by the diagnostic criteria of AMI.Coronary arteriongraphy was conducted with Judkins method,via right femoral artery with 6 F coronary arteriography catheter.The blood samples of the patients were obtained at set time.The serum concentrations of TroponinⅠ,BNP and CK-MB were determined,data were compared statistically.【Results】 The basic clinical data of the two groups had no significant difference,P 0.05.The TroponinⅠ,CK-MB and BNP levels during each phase in AMI group were significant higher than non-AMI group,P 0.05.The sensitivity and specificity of diagnosis of acute myocardial infarction with TroponinⅠ,CK-MB and BNP detected together were 98.3% and 89.0% respectively,which was obviously higher than their sensitivity and specificity detected lonely（TroponinI,BNP and CK-MB were 87.0%,82.2%,85.5%;79.6%,75.0%,73.4% respectively）,P 0.05.【Conclusion】TroponinⅠ,CK-MB and BNP detected together can improve the sensitivity and specificity efficiency in early diagnosis of acute myocardial infarction,which are in accordance with the diagnosis of coronary arteriongraphy.