高敏感肌钙蛋白Ⅰ在非心肌梗死疾病中低水平升高的特点分析

Analysis of the characteristics of low level elevation of high sensitive troponin Ⅰ in non-myocardial infarction patients

目的研究分析高敏感肌钙蛋白Ⅰ(hs-c TnⅠ)在非心肌梗死疾病中的升高特点,建立hs-c TnⅠ在这些疾病中诊断急性心肌梗死(AMI)的临床诊断界值。方法回顾性分析本院1279例hs-c TnⅠ升高的检测结果,将其分为11组:心肌梗死组、心绞痛组、心率失常组、心力衰竭组、脑血管意外组、慢阻肺组、重症肺炎组、肾功能衰竭组、急性中毒及重症感染组、糖尿病组、重度高血压组,并设立健康人群对照组,比较各组别间的中位数,并应用受试者工作特征(ROC)曲线评估其临床诊断界值。结果心肌梗死组、心绞痛组、心率失常组、心力衰竭组、脑血管意外组、慢阻肺组、重症肺炎组、肾功能衰竭组、急性中毒及重症感染组、糖尿病组、重度高血压组的hs-c TnⅠ与对照组比较差异有统计学意义(P<0.05)。ROC曲线显示hs-c TnⅠ的临床诊断界值为0.306ng/m L,其ROC曲线下面积(AUC)为0.943。结论高敏感肌钙蛋白Ⅰ在部分非心肌梗死疾病中也可见低水平的升高,为了更好鉴别诊断AMI,各临床实验室应根据各自的检测条件以及疾病人群确立适当的临床诊断界值。

Objective To study and analyze the elevated characteristics of high sensitive troponin I hs-cTnI in non-myocardial infarction disease,and to establish the clinical diagnostic threshold of hs-cTnI in the diagnosis of acute myocardial infarction(AMI).Methods The results of hs-cTnI elevation in 1279 patients were analyzed retrospectively and divided into 11 groups:myocardial infarction group,angina pectoris group,arrhythmia group,heart failure group,cerebrovascular accident group,slow obstructive lung group,severe pneumonia group,renal failure group,Acute poisoning and severe infection group,diabetes group,severe hypertension group,and healthy control group was set up,the median of each group was compared,and the clinical diagnostic threshold was evaluated by using the ROC curve of the subjects.Results Compared with the control group,the difference of hs-cTnI in myocardial infarction group,angina pectoris group,arrhythmia group,heart failure group,cerebrovascular accident group,slow obstructive lung group,severe pneumonia group,renal failure group,Acute poisoning and severe infection group,diabetes group,severe hypertension group were statistically significant(P<0.05).The ROC curve showed that the diagnostic threshold of hs-cTnI was 0.306 ng/mL,and the area under ROC curve was 0.943.Conclusion High-sensitive cardiac troponin I in some non-myocardial infarction disease also showed mild elevation,in order to differential diagnosis of AMI betterly,clinical laboratories should establish the appropriate clinical diagnostic cutoff value basing on their testing conditions and the scopes of the disease population.