急诊胸痛患者应用超敏肌钙蛋白T诊断急性心肌梗死的性能评价

Performance Evaluation of Sensitive Troponin T for the Diagnosis of Aacute Myocardial Infarction in Patients with Acute Chest Pain in Emergency Department

目的 在胸痛患者急诊就诊时,根据医生预估其患急性心肌梗死的可能性,比较血清超敏肌钙蛋白T（hs-TnT）和肌钙蛋白I（cTnI）的诊断价值.方法 2011年1月～2012年10月以急性胸痛就诊、疑似急性冠状动脉综合征患者601例,分别测定血清hs-TnT 及cTnI,在未获得实验室测定结果之前由两名以上医生依据临床资料预估其患急性心肌梗死的可能性,最终根据临床、影像和实验室的所有数据调整和确定诊断,根据最终诊断结果评价血清hs-TnT 及cTnI水平对急性心肌梗死的诊断性能.结果 ①601例患者中,医生判定有较低急性心肌梗死可能性者275例（45.8%）,有中度可能性者216例（36.0%）,有高度可能性者110例（18.3%）.急性心肌梗死确诊患者240例（39.9%）,其中有低、中度可能的为160例,高度可能的为80例.②hs-TnT 及cTnI用于诊断急性心肌梗死的ROC曲线下面积分别为0.93（95%可信区间为0.90～0.95）和0.88（95%可信区间为0.85～0.91）P＜0.001.hs-cTnT诊断心肌损伤的临界值为0.015 ng/ml,该点的灵敏度83.8%,特异度92.5%;cTnI的诊断临界点为0.065 ng/ml,该点的灵敏度65.4%,特异度98.0%.③在低、中度可能性组中,hs-TnT急性心肌梗死检出率明显高于cTnI,χ2=3.94,P＜0.05;对急性心肌梗死诊断灵敏度明显高于cTnI,分别为85.6%和68.8%,但两者的阴性预测值无显著差异,分别为89.9%和84.5%.结论 对于发生低、中度急性心肌梗死可能性的胸痛患者,血清hs-TnT 诊断急性心肌梗死的性能优于cTnI.

Objective According to doctors to predict the possibility of suffering from acute myocardial infarction （AMI） in the emergency patients with chest pain,to compare serum high sensitive troponin T （hs-TnT） and troponin I （cTnI） diag- nostic performance. Methods Acute chest pain, suspected in patients with acute coronary syndrome in 601 cases from Janu- ary 2011 to October 2012,respectively measured serum levels of hs-TnT and cTnI, without obtaining the laboratory before the determination results by 2 or more doctors according to evaluate its clinical data with the possibility of （AMI） ,and final- ly according to the clinical, imaging and laboratory all data to adj ust and determine the diagnosis, according to the final diag- nosis evaluated serum hs-TnT and cTnI levels on the diagnosis performance of AMI. Results OAll 601 cases of patients, doctors determine 275 cases （45.8 %） had a lower AMI possibility, 216 eases （35.9 %） had moderate possibility, 110 eases （18.3%） had a high possibility. AMI patients with confirmed 240 eases （39.9%） ,including low moderate possible for 160 cases, 80 eases of highly possible. （2）To cTnI was 0. 065 ng/ml,hs-cTnT was 0. 015 ng/ml for myocardial damage threshold, both with the diagnosis of AMI ROC curve area under were 0. 93 （95% CI,0.90~0. 95） and 0. 88 （95% CI,0. 85~0. 91） P d0. 001. （3）In low moderate possibility group,the sensitivity of acute myocardial infarction using hs-TnT were higher than cTnI,were 85.6% and 68. 8% respectively. But both negative predictive value was not significant,were 89. 9% and 84. 5% respectively （P〉 0.05）. Conclusion Serum hs-TnT in the diagnosis performance of AMI is superior to cTnI in patients with chest pain are low to moderate the likelihood of AMI.