心脏肌钙蛋白Ⅰ与肌红蛋白比值诊断急性心肌梗死

Diagnosis of acute myocardial infarction by ratio of cardiac troponin Ⅰ to myoglobin

目的研究心脏肌钙蛋白Ⅰ/肌红蛋白比值在诊断急性心肌梗死中的价值。方法选择2006年1月1日-2008年12月31日在苏州大学附属第一医院行肌红蛋白和肌钙蛋白检测的患者1075例,采用回归分析研究肌钙蛋白,肌钙/肌红蛋白比值以及肌红蛋白诊断急性心肌梗死的价值。接受者工作特征曲线(ROC)分析上述3个指标诊断急性心肌梗死临床界值。结果 Logistic回归分析表明,肌红蛋白的估计值为0.00106,标准误为0.000293,卡方值为13.0451,P值为0.0003,标准偏回归系数为0.1731;肌钙蛋白的估计值为0.0994,标准误为0.0194,卡方值为26.3095,P<0.0001,标准偏回归系数为1.9595;肌钙/肌红蛋白的估计值为4.7482,标准误为1.2454,卡方值为14.5367,P值为0.0001,标准偏回归系数为0.7561。ROC分析表明,肌钙蛋白曲线下面积(AUC)为0.918,95%可信区间0.898～0.936,P值为0.0001,界值为0.21;灵敏度为96.32%,95%可信区间为93.3%～98.2%;特异度为77.45%,95%可信区间为73.8%～80.8%。肌红蛋白AUC为0.635,95%可信区间为0.602～0.668,P值为0.0001,界值为112;灵敏度为51.47%,95%CI为45.4%～57.5%;特异度为71.26%,95%可信区间为67.4%～74.9%。肌钙/肌红蛋白比值AUC为0.815,95%可信区间0.787～0.840,P值为0.0001,界值为0.0112;灵敏度为72.79%,95%可信区间为67.1%～78.0%;特异度为82.79%,95%可信区间为79.5%～85.8%。ROC分析结果表明,两两相比肌钙蛋白诊断效能优于肌钙/肌红蛋白比值,而肌钙/肌红蛋白比值又优于肌红蛋白,差异均有统计学意义(P<0.05)。结论心脏肌钙蛋白/肌红蛋白比值是诊断急性心肌梗死的又一个有意义的指标。

Objective To study the ratio of cardiac troponin I to myoglobin in the diagnosis of acute myocardial infarction. Meth- otis 1075 consecutive patients underwent myoglobin and cardiac troponin I test from Jan 1st 2006 to Dec 31st 2008 in the First Affiliated Hospital of Soochow University. Logistic regression analysis was used to study the diagnostic values of the cardiac troponin I , the ratio of troponin I/myoglobin and the myoglobin in acute myocardial infarction. Receiver operating characteristic（ROC） curve analysis studied the diagnostic power of the above - mentioned 3 indices. Results Logistic regression analysis showed that myoglobin estimate of the value was 0. 00106, standard error was 0. 000293, chi - square value was 13. 0451, P = 0. 0003, the standard partial regression coefficient was 0. 1731. The estimated value of cardiac troponin was 0. 0994, standard error was O. 0194, chi - square value was 26. 3095, P 〈 0. 0001, the standard partial regression coefficient was 1. 9595. The cTnL/MYO estimated value was 4. 7482, standard error was 1. 2454, the chi - square value was 14. 5367, P =0. 0001, the standard partial regression coefficient was O. 7561. ROC demonstrated that the area under the curve （AUC） of the cardiac troponin I was 0. 918, 95 % confidence interval （CI） 0. 898 - 0. 936, P = 0. 0001, the cut - off value was 0. 21, sensitivity was 96. 32% , 95% CI was 93.3% - 98.2% , specificity was 77.45% , and 95% CI was 73, 8% - 80. 8%. The AUC of myoglobin was 0. 635, 95% CI was 0. 602 - 0. 668, P = 0. 0001, the cut - off value was 112, sensitivity was 51.47%, 95% CI was 45.4% - 57. 5%, speeifieity was 71.26%, 95% CI was 67. 4% - 74. 9%. The AUC of the ratio of cardiac troponin Ⅰ fmyoglobin was0. 815, 95 % CI 0. 787 - 0. 840, P = 0. 0001, the cut - off value was 0. 0112, sensitivity was 72. 79%, 95% CI was 67. 1% - 78.0%, specificity was 82.79%, 95% CI 79, 5% - 85.8%. ROC also demonstrated that the diagnostic power of cardiac troponin Ⅰ was better than the one of the ratio of cardiac troponin Ⅰ/myoglobin, and the one of the the ratio of cardiac troponin Ⅰ/myoglobin was better than the one of the myoglobin, all with significant differences （ P 〈 0. 05 ）. Conclusion The ratio of troponin I to myoglobin is another meaningful indi- cator in diamaosis of acute myocardial infarction.