肌钙蛋白Ⅰ的即时检测(POCT)临床应用分析

The clinical application analysis of cardiac troponin I concentration with the use of point of care testing

目的探讨血清心肌钙蛋白I(cTnI)用瑞莱多功能免疫检测仪(ReLIA SSJ-2 POCT SYSTEM)测定的临床应用效果以及该仪器的检测结果与贝克曼化学发光分析仪ACCESS 2之间的差异。方法分别采用化学发光仪和POCT仪测定102例患者的血清cTnI含量,POCT法以cTnI<0.15 ng/mL为正常参考值,化学发光法以<0.04 ng/mL为正常参考值将患者分为cTnI增高组和正常组,比较两组心肌受损事件发生的阳性诊断率。结果在102例胸痛患者中,POCT测定cTnI增高72例,ACESS 2测定cTnI增高67例;两种测定方法在心肌损伤事件的阳性诊断率上差异有统计学意义(P<0.05);POCT检测cTnI增高对心肌损伤的阳性和阴性预测值分别为93.1%和85.7%。结论用瑞莱多功能免疫检测仪测定血清心肌钙蛋白I对心肌梗死有良好的阳性预测值,但其灵敏度和特异度不及化学发光分析仪,在0.15 ng/mL^0.4 ng/mL时存在灰区。

[ Objective ] To explore the clinical application of Cardiac Troponin I concentration with the use of ReLIA SSJ-2 POCT SYSTEM and compare the results of concentration of Cardiac Troponin I using this method and Beckman Chemiluminescent analyzer ACCESS 2. [ Methods ] POCT SYSTEM and Chemiluminescent analyzer ACCESS 2 are introduced to determine Cardiac Troponin in the sample of randomLy selected 102 patients, cTnI 〈0.15 ng/mL is the normal reference range for POCT method while cTnI 〈0.04 ng/mL is the normal reference range for ACCESS 2. According to these standards the patients are divided into cTnI positive group and cTnI negative group and cTnI positive rates are compared between these two groups. [ Resluts ] There are 72 cases of cTnI positive under POCT method while only 67 cases under ACCESS 2. These two methods are statistically significant （P〈0.05）in determining the difference of Cardiac Troponin positive rate. The positive predictive value and negative predictive value for myocardial damage was 93.1% and 85.7% respectively with the use of POCT SYSTEM. [ Conclusion ] ReLIA SSJ-2 POCT SYSTEM for the cTnI determination was good at the myocardial infarction prediction, but the sensibility and specificity were inferior to Chemiluminescent analyzer ACCESS 2, the gray zone was between 0.15 ng/mL-0.4 ng/mL for the POCT method.