心肌标志物作用的系统分析

The Systematic Review of Cardiac Markers Application

目的 :获取心肌生化标记物的最佳应用证据。方法 :查循、浏览对心肌肌酸激酶同工酶MB (CK -MB)、肌红蛋白、心肌肌钙蛋白T (cTnT)和心肌肌钙蛋白I (cTnI)用于诊断心肌梗塞 (MI)和对急性冠状动脉综合症分级的系统评价和Meta-分析的文献资料。结果 :在症状发生后的 12～ 48小时采样分析CK -MB质量对于诊断MI的临床灵敏度和特异性分别是 98 8%和 89 6 %。肌红蛋白有高的阴性预示值 ,在症状发生后的 2～ 6小时采样分析有高的临床灵敏度。在症状发生后的 12小时采样分析cTnI,诊断MI可达到最佳临床灵敏度 ,临床灵敏度和特异性分别是 90 %和 97%。在症状发生后的 12小时采样分析cTnT ,诊断MI的临床灵敏度和特异性分别是 98 2 %和 6 8 8% ,其临床特异性降低与检测到微小心肌受损有关。结论 :cTnT和cTnI比CK -MB对于诊断心肌梗死和预测急性冠状动脉综合症危险性更有价值。

Objective:To look for the best evidence for the application of biochemical cardiac markers.Methods:To explore systematic review and Meta-analysis evidence of use CK-MB,myoglobin,cardiac troponin T(cTnT)and cardiac troponin I(cTnI)for diagnosis of mycardial infarction(MI)and risk stratification of the acute coronary syndromes.Results;CK-MB mass for diagnosis of MI yieldded a clinical sensitivity and specificity are 98 8% and 89 6% respectively for sampling at 12-48 hours.Myoglobin has high negative predictive value and high sensitivity 2-6 hours after presentation.Clinical sensitivity and specificity of cTnI are 90% and 97% respectively for sampling over 12 hours after symptoms onset.cTnT had a sensitivity of 98 2% for diagnosis of MI with lower specificity due to detection of minor myocardial injury.Conclution:Both cTnT and cTnI are more useful for diagnosising mycardial infarction and stratifying risk in acute coronary syndrome patients than CK-MB.