入院3h内超敏肌钙蛋白I绝对变化值及其变化斜率对急性心肌梗死的预测价值

Analysis of the predictive value of hs-cTnI absolute change value and change slope to acute myocardial infarction within 3hours after admission

目的:分析入院3h内超敏肌钙蛋白I(hs-cTnI)绝对变化值及其变化斜率对急性心肌梗死(AMI)的预测价值。方法:120例急诊胸痛就诊的患者作为研究对象,根据最终诊断分为AMI患者86例(AMI组)、非AMI患者(非AMI组)34例,均行血常规检测,通过直接化学发光免疫分析法检测hs-cTnI,计算AMI患者入院3 h内hs-cTnI绝对变化值及其变化斜率(△hs-cTnI)。采用受试者工作特征(ROC)曲线评价入院3h内hs-cTnI绝对变化值和△hs-cTnI对AMI的预测价值。结果:AMI组入院时血清hs-cTnI、丙氨酸氨基转移酶(ALT)、B型钠尿肽(BNP)、C反应蛋白(CRP)均明显高于非AMI组(P<0.01),而两组血肌酐比较差异无统计学意义(P>0.05);在AMI组与非AMI组中,入院时、入院3h时hs-cTnI诊断AMI的ROC曲线下面积分别为0.89、0.96,此时对应的最佳诊断阈值分别为0.10、0.51ng/mL,敏感度分别为86.05%、91.86%,特异度分别为91.18%、100.00%。在AMI组与非AMI组中,入院3h内hs-cTnI绝对变化值诊断AMI的ROC曲线下面积为0.95,此时对应的最佳诊断阈值为0.46ng/mL,敏感度和特异度分别为90.70%、100.00%。以非AMI组为基线对照,AMI组△hs-cTnI拟合曲线斜率为3.23,其与非AMI组比较具有统计学意义(P<0.01)。结论:入院3h内hs-cTnI绝对变化值及其变化斜率对AMI具有良好的预测价值。

Objective:To analyze the predictive value of absolute change value and change slope of high sensitivity troponin I(HS cTnI)in patients with acute myocardial infarction(AMI).Method:One hundred and twenty patients with chest pain were divided into AMI group(86cases)and non AMI group(non AMI group)according to the final diagnosis.Blood routine test was performed.HS cTnI was detected by direct chemiluminescence immunoassay.The absolute change value and change slope of HS cTnI in AMI patients within 3hours after admission were calculated.Receiver operating characteristic(ROC)curve was used to evaluate the absolute change of HS cTnI and the predictive value of△HS cTnI for AMI.Result:The levels of serum HS cTnI,alanine aminotransferase(ALT),B-type natriuretic peptide(BNP)and C-reactive protein(CRP)in AMI group were significantly higher than those in non AMI group(P<0.01),while there was no significant difference in serum creatinine between the two groups(P>0.05)The area under the ROC curve of HS cTnI was 0.89and 0.96respectively at h,and the corresponding optimal diagnostic thresholds were 0.10ng/mL and 0.51ng/mL,the sensitivity was 86.05%,91.86%,and the specificity was 91.18%and 100.00%,respectively.In AMI group and non AMI group,the area under ROC curve of absolute change value of HS cTnI within 3hours after admission was 0.95,the corresponding optimal diagnostic threshold was 0.46ng/mL,the sensitivity and specificity were 90.70%and 100.00%,respectively.Taking non AMI group as baseline control,the slope of△HS cTnI fitting curve in AMI group was 3.23,which was statistically significant compared with non AMI group(P<0.01).Conclusion:The absolute change value and change slope of HS cTnI within 3hours after admission have good predictive value for AMI.