探讨高敏肌钙蛋白I联合常规心肌标志物对微小心肌损伤的诊断价值

Diagnostic value of high-sensitivity troponin I combined with routine cardiac markers in minor myocardial damage

目的探讨高敏肌钙蛋白I(hs-cTnI)和常规心肌标志物在微小心肌损伤(MMD)早期诊断中的价值。方法测定172例MMD患者血清hs-cTnI及心肌标志物(CK、CK-MB、hs-CRP、cTnI、Mb)的浓度,根据患者胸痛发作至采血时间分为<3 h组和3 h^6 h组。MMD组包括不稳定型心绞痛(UA)68例、非ST段抬高心肌梗死(NSTEMI)45例,ST段抬高心肌梗死(STEMI)34例。选择80例健康体检者作为对照组。结果观察组检测值、阳性率均明显高于对照组,差异有统计学意义(P<0.05),其中hs-cTnI阳性率最高,为93.6%。胸痛时间3 h^6 h组各项指标水平均高于胸痛时间<3 h组、对照组,各组之间比较差异均有统计学意义(P<0.05)。MMD组中UA、NSTEMI、STEMI患者血清各项指标水平均高于NICP组和对照组,差异有统计学意义(P<0.05)。MMD组中STEMI患者血清各项指标均高于UA和NSTEMI患者,差异有统计学意义(P<0.05)。结论 hs-cTnI是MMD早期诊断的敏感指标,多项指标联合检测对MMD的早期诊断有重要临床意义。

Objective To investigate the early diagnosis value of the high- sensitivity troponin I（ hs- cTnI） and conventional cardiac markers in minor myocardial damage（ MMD）. Methods The levels of hs- cTnI and conventional cardiac markers（ CK,CK- MB,hs- CRP,cTnI and Mb） in 172 MMD cases were determined. According to the blood collection time after stethalgia,the MMD patients were divided into 3 h group and 3 h- 6 h group. MMD group included 68 cases with unstable angina（ UA）,45 cases with non- ST- elevation myocardial infarction（ NSTEMI） and 34 cases with ST- elevation myocardial infarction（ STEMI）. 80 healthy persons for medical examination was used as controls. Results Detection value and positive rate were significantly higher in the observation group than that in healthy controls,with the differences statistically significant（ P〈0. 05）. The positive rate of hs- cTnI was the highest（ 93. 6%）. Index in chest pain 3 h- 6 h group were higher than 3 h group and the controls,and the difference among the groups were statistically significant（ P〈0. 05）. All indicators of UA,NSTEMI,STEMI patients in MMD group were higher than the NICP group and the control group,with the differences statistically significant（ P〈0. 05）. All indicators in STEMI patients of MMD group were higher than the UA and NSTEMI patients,and the differences were statistically significant（ P〈0. 05）. Conclusion The serum hs- cTnI is a sensitive indicator in the early diagnosis of MMD. Joint detection has important clinical significance for the early diagnosis of MMD.