联合检测Myo、cTnⅠ、hs-CRP在急性心梗中的临床应用价值研究

Clinical Value of Combined Detection of Myo, cTnⅠ and hs-CRP in Acute Myocardial Infarction

目的探究Myo(肌红蛋白)、cTnⅠ(肌钙蛋白Ⅰ)、hs-CRP(超敏C-反应蛋白)的联合检测在急性心梗(AMI)中的临床应用价值。方法方便选取2017年5月-2018年4月92例成年人作为观察对象,其中在该院确诊为急性心梗的46例患者列为研究组,另外46名为健康的成年人,将其作为对照组。所有观察对象均予以Myo、cTnⅠ、hs-CRP联合检测,对比两组的指标检查结果、研究组的不同时段的指标阳性率以及研究组检测的灵敏度、特异度、准确度、阳性拟然比。结果研究组症状发作后12 h的Myo、cTnⅠ以及hs-CRP水平均显著高于对照组(t=16.25、62.99、59.01,P<0.05);研究组的AMI患者在入院初期Myo阳性率即可达到71.74%,入院24 h达到峰值随后开始降低;cTnⅠ与hsCRP在入院24 h后展现出较高的阳性率(>90%);研究组cTnⅠ的检测敏感性(94.56%)、阳性拟然比(52.83%)较高;研究组的Myo+cTnⅠ+hs-CRP 3项联合诊断AMI与Myo+cTnⅠ两项联合诊断相比,敏感性提高不大,且阳性拟然下降幅度较大。结论 cTnⅠ是最能体现急性心梗的标志物,Myo与cTnⅠ检测在AMI早期诊断中有重要价值,联合hs-CRP不能提高AMI的诊断敏感性,但可提示大范围组织坏死可能性。

Objective To investigate the clinical value of combined detection of Myo(myoglobin), cTnⅠ(troponin Ⅰ) and hs-CRP(supersensitive C-reactive protein) in acute myocardial infarction(AMI). Methods A total of 92 adults from May 2017 to April 2018 were convenient enrolled. Among them, 46 patients diagnosed as acute myocardial infarction in our hospital were included in the study group, and 46 patients were healthy adults. All subjects were tested by Myo, cTnⅠ and hs-CRP.The results of the index examination, the positive rate of the study group at different time periods, and the sensitivity, specificity, accuracy and positive likelihood ratio of the study group were compared. Results The levels of Myo, cTnⅠ and hsCRP in the study group were significantly higher than those in the control group(t=16.25, 62.99, 59.01, P<0.05). The AMI patients in the study group achieved the positive rate of Myo at the early stage of admission of 71.74%, peaked at 24 h after admission and then began to decrease;cTnⅠ and hs-CRP showed a higher positive rate(>90%) after admission for 24 h;the detection sensitivity of cTnⅠ in the study group(94.56%), positive likelihood ratio( 52.83%) was higher;the sensitivity of the combination of Myo+cTnⅠ+hs-CRP combined diagnosis of AMI and Myo+cTnⅠ was not significantly improved, and the positive rate of decline was larger. Conclusion cTnⅠ is the most effective marker for acute myocardial infarction. Myo and cTnⅠ detection are of great value in the early diagnosis of AMI. Combination of hs-CRP can not improve the diagnostic sensitivity of AMI, but it may suggest the possibility of large-scale tissue necrosis.