心肌标志物检测在早期诊断急性心肌梗死中的价值

The early diagnosis value of detecting cardiac markers in acute myocardial infarction

目的探讨胶体金免疫层析法检测血清肌钙蛋白I、肌酸激酶同工酶(CK-MB)、肌红蛋白在急性心肌梗死(AMI)患者早期不同时间段的诊断价值。方法收集该院2011年1月至2012年12月收治的89例AMI病例,根据发病时间分为两组,2～<6h组42例,6～12h组为47例,非心肌梗死对照组70例。采用血清肌钙蛋白I、CK-MB、肌红蛋白三合一诊断试剂对选取的病例进行测定。结果 AMI患者肌钙蛋白I、CK-MB、肌红蛋白的阳性率均高于对照组(P<0.05),在2～<6h时间段内三者的敏感度分别为35.7%、64.3%、52.4%,均低于6～12h时间段的48.9%、85.1%、76.6%,结果差异有统计学意义(P<0.05)。CK-MB用于诊断的敏感度在两个时间段内分别为:64.3%、85.1%,较肌钙蛋白I(35.7%、48.9%)、肌红蛋白(52.4%、76.6%)高,差异有统计学意义(P<0.05),而肌红蛋白敏感度较肌钙蛋白I高(P<0.05)。将三者联合测定时,阳性率高于单独测定时的阳性率,2～6h组阳性率为69.0%,6～12h组阳性率为89.4%。结论在AMI早期,肌钙蛋白I、CK-MB、肌红蛋白单独测定阳性率较低,不能满足临床需要,而采用胶体金法心肌三合一诊断试剂盒,对肌钙蛋白I、CK-MB、肌红蛋白进行联合测定能提高AMI的早期诊断阳性率,以便为临床提供可靠的实验信息,及时采取有效的治疗措施,从而降低患者的病死率。

Objective To explore the early diagnostic value of colloidal gold immune chromatography testing serum troponin I, creatine kinase isoenzyme （CK-MB）, myoglobin in different periods among patients with acute myocardial infarction. Methods Eighty-nine patients diagnosed with AMI from January 2011 to December 2012 in Suining central hospital were divided into two groups：2-〈6 h group with 42 cases,and 6-12 h group with 47 cases. The control group included seventy non-AMI patients. All the cases were tested serum troponin I,CK-MB and myoglobin by colloidal gold immune chromatography. Results The positive rate of myocardial troponin I,CK-MB,myoglobin in AMI patients were higher than that of the control group（P〈0.05）. In 2-〈6 h group,the sensitivity of the three cardiac markers were 35.70/00.64.30/00,52.40/00, respectively, lower than these of 6--12 h group, 48.9%,85.1% and 76.6%, respectively. There were statistical difference between the two groups（P〈0.05）. The sensitivity of CK MB was 64.3% in 2-〈6 h group and 85.1% in 6-12 h group,significantly higher than that of troponin I （35.7%,48.9%, respectively） and myoglobin（52.4 %, 76.6 %, respectively）. In addition, compared with troponin I, the sensitivity of myoglobin was higher（P＇~0.05）. And all of the difference had statistical significance. The positive rate of combined detection was obviously higher than that of single detection （P〈0.05） ：69.0% in 2-〈6 h group and 89.4% in 6-12 h group. Conclusion In early stage of AMI, the low positive rate by detecting a seperated cardiac marker cannot meet the clinical needs, while combined detection of serum troponin I, CK-MB,myoglobin by colloidal gold immune chromatography could develop the positive rate in AMI diagnosing,in order to provide reliable information and reduce the mortality rate.