心肌标志物检测在急性胸痛患者中的应用

Myocardial markers in the use of patients with chest pain

目的:探讨血清缺血修饰清蛋白(IMA)、肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(CTnI)的检测对急性胸痛患者早期诊断价值。方法:研究137例急性胸痛患者,经临床诊断分为急性冠状动脉综合征(ACS)组和非急性冠状动脉综合征组,在胸痛≤2h、4h、6h、12h、24h分别测定IMA、Mb、CK-MB、CTnI。结果:急性冠状动脉综合征组在胸痛≤2h时IMA、Mb、CK-MB、CTnI敏感度分别为83.3%、30.3%、19.7%、10.6%,IMA敏感度与其他指标比较差异有统计学意义(P<0.05)。在胸痛4h时IMA、Mb、CK-MB和CTnI联合检测敏感度为95.5%,均高于单项检测,差异有统计学意义(P<0.05)。结论:在急性冠状动脉综合征早期,IMA是比较灵敏的指标,IMA、Mb、CK-MB、CTnI联合检测对于急性冠状动脉综合征的诊断和排除诊断有较高的临床价值。

Objective To investigate the diagnostic value of myocardial markers including ischemia modified album（IMA）、 myohemoglobin（Mb）、creatine kinase isozyme（CK-MB） and cardiac tropnin I（cTnI）in patients with chest pain.Methods 137 patients with acute chest pain were in the investigation.Four myocardial markers（IMA、Mb、CK-MB and cTnI）were monitored continually at different timepoints（2 h、4 h、6 h、12 h and 24 h after chest pain onset）.Results In the group of acute coronary syndrome,the sensitivity was 83.3%for IMA、 30.3%for Mb、19.7% for CK-MB and 10.6% for cTnI at 2 h time-point.The sensitivity of IMA was remarkable different from the others（P〈0.05）.The sensitivity of combined detection of IMA,Mb,CK-MB and cTnl was 95.5%,much higher than any single detection at 4h time-point（P〈0.05）.Conclusion IMA is an early and sensitive marker for acute coronary syndrome.Combined detection of IMA,Mb,CK-MB and cTnI significantly enhances sensitivity and has a high practical clinical value.