增强型心肌肌钙蛋白I检测在急性冠状动脉综合征诊断中的应用

Application of enhanced cardiac troponin I determination in clinical diagnosis of acute coronary syndrome

目的观察增强型心肌肌钙蛋白I(cTnI)[即高敏cTnI(hs-cTnI)]在正常人群及急性冠状动脉综合征(ACS)人群中的分布情况并探讨其在ACS诊断中的应用。方法选择胸痛12 h以内的ACS患者80例、同期入院稳定性心绞痛(SA)患者26例和正常对照者60名,检测外周血中hs-cTnI和上一代cTnI浓度,同时检测血常规、C反应蛋白(CRP)等指标。通过受试者工作曲线(ROC)评估hs-cTnI的诊断效能。结果 ACS组、SA组及正常对照组间hs-cTnI、cTnI差异均有统计学意义(P<0.05)。hs-cTnI的ROC曲线下面积(AUC)为0.986±0.014,高于cTnI的AUC(0.915±0.035)(P=0.034),而与hs-cTnI联合CRP、中性粒细胞百分率、中性粒细胞/淋巴细胞比值及白细胞计数的AUC(0.978±0.018)无差异(P>0.05)。当hs-cTnI取0.02 ng/mL为最佳临界值,此时诊断ACS的效率最高。结论 hs-cTnI对早期ACS的诊断效率较上一代cTnI有所提高,但联合炎症指标没有提高其诊断价值。

Objective To observe the distribution of enhanced cardiac troponin I（cTnI）[high sensitive cTnI（hs-cTnI）] in healthy subjects and patients with acute coronary syndrome（ACS）,and investigate the application of hs-cTnI in the diagnosis of ACS.Methods A total of 80 ACS patients who had chest pain onset within 12 h,26 stable angina（SA） patients and 60 healthy controls were enrolled.The hs-cTnI,conventional cTnI,blood routine tests,C reactive protein（CRP） and other indices were determined among the groups.The receiver operating characteristic（ROC） curve was used to analyze the diagnosis performance of hs-cTnI determination.Results The concentrations of hs-cTnI had statistical significance among ACS,SA and control groups.The area under ROC curve（AUC） of hs-cTnI（0.986±0.014） was significantly higher than that of conventional cTnI（0.915±0.035,P=0.034）.The AUC of hs-cTnI had no difference with those of hs-cTnI combined with CRP,neutropil granulocyte percentage/lymphocyte percentage ratio and white blood cell count（0.978±0.018,P0.05）.When the cut-off value was 0.02 ng/mL,the diagnosis performance was the best.Conclusions Compared with the conventional cTnI,the hs-cTnI has diagnosis performance in early diagnosis of ACS.There is no diagnosis value in combined of inflammation indices.