和肽素联合高敏心肌肌钙蛋白I对心肌肌钙蛋白轻度增高的急性心肌梗死的早期诊断价值

Early diagnostic value of copeptin with high-sensitivity cardiac troponin I in acute myocardial infarction with mild increased myocardial troponin

目的 探讨和肽素联合高敏心肌肌钙蛋白I(high-sensitivity cardiac troponin I,hs-cTnI)对肌钙蛋白轻度增高的急性心肌梗死的早期诊断价值。方法 选取2019年6月至2020年6月河北大学附属医院心内科冠心病监护病房收治的42例cTnI轻度增高的疑诊急性心肌梗死患者为研究对象,入院即刻和入院后1h抽取静脉血,采用酶联免疫吸附法检测和肽素及hs-cTnI水平。根据冠脉造影结果将患者分为急性心肌梗死组(37例)和非急性心肌梗死组(5例)。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估hs-cTnI及和肽素诊断急性心肌梗死的临床效能。结果 根据ROC曲线分析,入院时及入院后1h和肽素诊断肌钙蛋白轻度增高的急性心肌梗死的曲线下面积(area under the curve,AUC)分别为0.730(95%CI 0.560~0.899)、0.589(95%CI 0.387~0.792);hs-cTnI诊断肌钙蛋白轻度增高的急性心肌梗死的AUC分别为0.757(95%CI 0.599~0.915)、0.805(95%CI 0.621~0.990)。和肽素与hs-cTnI联合诊断肌钙蛋白轻度增高的急性心肌梗死的AUC为0.811(95%CI 0.666~0.956),高于和肽素及hs-cTnI单独检测。结论 和肽素联合hs-cTnI早期诊断肌钙蛋白轻度增高的急性心肌梗死的效能优于二者单独检测,入院后1h复测hs-cTnI可作为肌钙蛋白轻度增高的急性心肌梗死早期诊断的有效指标。

Objective To explore the value of combined detection of copeptin and high-sensitivity cardiac troponin I(hs-cTnI)in the early diagnosis of acute myocardial infarction with mildly elevated troponin I.Method 42 cases of suspected acute myocardial infarction patients with mildly elevated troponin I hospitalized in CCU,Department of Cardiology,Affiliated Hospital of Hebei University from June 2019 to June 2020 were selected as the research object.Venous blood was colleted at admission and 1h after admission.The levels of peptidin and hs-cTNI were detected by enzyme-linked immunosorbent assay.The levels of hs-cTnI and copeptin were compared with the results of coronary angiography,and the ROC curve evaluated the diagnostic performance of hs-cTnI and copeptin on acute myocardial infarction.Result According to ROC curve analysis,the AUC of acute myocardial infarction with slightly increased troponin at admission and 1h copeptin was 0.730(95%CI 0.560-0.899)and 0.589(95%CI 0.387-0.792),respectively.The admission hs-cTnI AUC was 0.757(95%CI 0.599-0.915);1h hs-cTnI AUC is 0.805(95%CI 0.621-0.990).The 1h hs-cTnI AUC value is the largest,which is the most valuable for the early diagnosis of acute myocardial infarction.The 1h AUC of copeptin is smaller than that of 0h,and the retest and copeptin at 1h cannot improve the diagnostic value;the combined detection AUC of copeptin and hs-cTnI is 0.811(95%CI 0.666-0.956)higher than that of copeptin and hs-cTnI is tested separately.Conclusion The combined detection of hs-cTnI with copeptin is better than the detection of hs-cTnI alone in the early diagnosis of acute myocardial infarction with mildly increased troponin.Retesting hs-cTnI at 1 hour can be used as an effective indicator for the early diagnosis of acute myocardial infarction with mildly increased troponin.