心肌损害标志物的评价及应用策略

The Evaluation and Application of Cardiac Damage Markers.

根据血清中有关酶 (如 :天门冬氨酸氨基转移酶 (AST)、乳酸脱氢酶 (LD)、肌酸激酶及其同工酶 (CK MB) )活性的变化来诊断急性心肌梗塞 (AMI)已有多年的历史 .近年来 ,一些蛋白质标志物 ,如 :CK MB质量 ,心肌肌红蛋白 ,心肌肌钙蛋白 (cTn)也已逐渐应用于临床诊断 .其中心肌肌红蛋白是一项良好的排除心肌梗塞的指标 ,而心肌肌钙蛋白则是很好的确证指标 .CK MB质量的分析性能高于其活性测定 .蛋白质标志物分析还可用于冠心病的危险分级及监测治疗 .血清酶分析由于价廉、方法成熟 ,也不失为有效的AMI辅助诊断指标 .

It has been many years to diagnose acute myocardial infarction (AMI) by evaluating the activity of serum enzymes such as asartate aminotransferase (AST), lactate dehydrogenase (LD), creatine kinase (CK) and their isoenzymes. In recent year, some protein markers, such as CK MB mass, myoglobin, troponinT and troponin I have been used in clinical diagnosis. Myoglobin is a good marker to rule out AMI because of its high negative predictive value (NPV), troponin is a good marker to confirm diagnosis because of its high clinical specificity. The analysis property is better than that of CK MB. Protein markers can be used to do risk stratification and monitor treatment as well. Due to the low price of analysis, serum enzymes are still effective markers for assistance of AMI diagnosis. Sampling time is very important for the evaluation of all these markers.