心肌肌钙蛋白联合动态心电图在急诊胸痛疑似ACS患者早期诊断中的应用价值探析

Value of Cardiac Troponin Combined with Dynamic Electrocardiogram in Early Diagnosis of Patients with Acute Chest Pain Suspected of ACS

目的:探析心肌肌钙蛋白(cardiac troponin,cTn)联合动态心电图(dynamic electrocardiogram,DCG)在急诊胸痛疑似急性冠状动脉综合征(acute coronary syndrome,ACS)患者早期诊断中的应用价值。方法:选取2016年10月-2019年10月本院接收的急诊胸痛疑似ACS患者187例,以临床综合诊断作为ACS的检验金标准,同时采用常规心电图(electrocardiogram,ECG)与DCG对患者进行监测,采集患者的静脉血行cTn检测,比较两种检测方法的ACS阳性、阴性检出率,判断两种诊断方式对ACS的诊断率、灵敏度与特异度。结果:187例急诊疑似ACS患者经临床综合诊断,128例确诊为ACS,检出率为68.45%。经DCG检出ACS患者88例,检出率为68.75%;cTn检出ACS患者107例,ACS检出率为83.59%。cTn检测ACS检出率显著高于DCG(P<0.05);非ACS患者cTn水平、Gensini积分均显著低于ACS患者(P<0.05);cTn联合DCG检测对疑似ACS的阳性检出率、灵敏度、特异度及准确度均高于单项检测(P<0.05),漏诊率与误诊率均低于单项检测(P<0.05)。结论:相较于单项检测,cTn联合DCG检测对ACS的阳性检出率、灵敏度、特异度及准确度更高,且误诊率与漏诊率更低。

Objective:To investigate the value of cardiac troponin(cTn)combined with dynamic electrocardiogram(DCG)in the early diagnosis of patients with acute chest pain suspected of acute coronary syndrome(ACS).Method:A total of 187 patients with acute chest pain suspected of ACS who admitted to the hospital from October 2016 to October 2019 were selected as the subjects.With clinical comprehensive diagnosis as the golden standard for ACS,patients were monitored with conventional electrocardiogram(ECG)and DCG.The patients’venous blood was collected for cTn detection.The positive and negative detection rates of ACS were compared between the two methods.The diagnosis rates,sensitivities and specificities of the two methods for ACS were evaluated.Result:187 cases of suspected ACS in emergency department were diagnosed comprehensively,128 cases were diagnosed as ACS,the detection rate of ACS was 83.59%.88 patients with ACS were detected by DCG,the detection rate was 68.75%.107 patients with ACS were detected by cTn,the detection rate was 83.59%.The detection rate of ACS by cTn was significantly higher than that by DCG(P<0.05).The cTn level and Gensini score of patients without ACS were significantly lower than those with ACS(P<0.05).The positive detection rate,sensitivity,specificity and Accuracy of cTn combined with DCG detection for ACS were higher than those of single detection(P<0.05).The missed diagnosis rate and misdiagnosis rate were lower than those of single detection(P<0.05).Conclusion:Compared with single detection,cTn combined with DCG detection for ACS has higher sensitivity and specificity,the misdiagnosis rate and omission diagnostic rate are lower.