不同性别及年龄患者超敏肌钙蛋白Ⅰ的截断值对急性心肌梗死的临床价值

The clinical value of cutoff value of high-sensitivity cardiac troponinⅠin the AMI patients with different genders and ages

目的探讨不同性别、不同年龄患者超敏肌钙蛋白Ⅰ(hs-cTnI)的截断值对急性心肌梗死(AMI)的诊断意义。方法选取2019年2月至2019年12月就诊于河北医科大学第二医院急诊科疑似急性冠脉综合征(acute coronary syndrome,ACS)患者236例,收集患者入院时超敏肌钙蛋白Ⅰ(hs-cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)等心脏损伤标志物的浓度,对其按性别、年龄及最终诊断进行分类统计,根据受试者工作特征(ROC)曲线及约登指数(Youden)判断hs-cTnI最佳诊断分界点,并评估不同hs-cTnI的截断值对AMI的诊断意义。结果本研究纳入236例疑似ACS患者,平均年龄(61.95±11.96)岁,其中低年龄组155例,高年龄组81例。男性患者AMI比例高于女性(66.9%vs.45.3%,P<0.05),其中低年龄组男性发生AMI的比例要高于低年龄组女性(65.2%vs.38.1%,P<0.05)。不同性别、年龄AMI患者心肌损伤标志物差异有统计学意义(P<0.05):男性心肌损伤标志物高于女性(hs-cTnI:2.598±0.879 vs.1.697±0.567、CK:552.207±198.657 vs.505.083±180.153、CK-MB:107.494±36.675 vs.74.002±23.897);高年龄组心肌损伤标志物高于低年龄组(hs-cTnI:1.392±0.348 vs.3.736±1.086、CK:422.595±108.543 vs.627.216±198.650、CK-MB:70.083±22.982 vs.137.392±24.732)。ROC曲线显示,在AMI患者中总体hs-cTnI截断值为0.176 ng/mL,AUC为0.940(0.931~0.962);男性hs-cTnI截断值为0.238 ng/mL,AUC为0.943(0.917~0.970);女性hs-cTnI的截断值为0.130 ng/mL,AUC为0.966(0.911~0.992);低年龄组hs-cTnI截断值为0.152 ng/mL,AUC为0.954(0.908~0.981);高年龄组hs-cTnI截断值为0.475 ng/mL,AUC为0.993(0.942~1.000)。采用总体、性别和年龄hs-cTnI截断值对AMI诊断的敏感度分别为89.83%、89.86%、96.12%,特异度分别为96.52%、96.55%、96.55%,阳性预测分别为96.89%、96.88%、96.88%,阴性预测值分别为88.88%、88.89%、88.19%。结论不同性别、年龄界定的hs-cTnI截断值不同,其中男性hs-cTnI的截断值高于女性,高龄组截断值高于低年龄组。采用不同人群(性别、年龄)hs-cTnI的截断值可更准确地筛选出AMI高危人群,避免误诊、漏诊。

Objective Explore the diagnostic significance of high-sensitivity cardiac troponinⅠ(hs-cTnI)cut-off values of different genders and ages for acute myocardial infarction(AMI).Methods A total of 236 patients with acute coronary syndrome(ACS)admitted to the emergency department of the Second Hospital of Hebei Medical University from February 2019 to December 2019 were selected,and the concentrations of heart injury markers were collected at the time of admission,such as hs-cTnI,creatine kinase(CK),creatine kinase isoenzyme-MB(CK-MB),myoglobin(MYO).The patients were divided into different groups by sex,age and final diagnosis.The optimal diagnostic demarcation point of hs-cTnI was determined according to the receiver operating characteristic(ROC)curve and Youden index,and the meaning of the cut-off values of different hs-cTnI for the AMI diagnosis were evaluated.Results The study included 236 suspected ACS patients,and average age of patients(61.95±11.96)years,of which 155 were in the low age group and 81 in the high age group.The proportion of men with AMI was higher than that of women(66.9%vs.45.3%,P<0.05),and the proportion of men with AMI was higher than that of women in the lower age group(65.2%vs.38.1%,P<0.05).There were differences in cardiomyopathy markers of the patients with different genders and ages(P<0.05),cardiomyopathy markers were higher in males than in females(hs-cTnI:2.598±0.879 vs.1.697±0.567,CK:552.207±198.657 vs.505.083±180.153,CK-MB:107.494±36.675 vs.74.002±23.897);cardiomyopathy markers were higher in the high age group than in the low age group(hs-cTnI:1.392±0.348 vs.3.736±1.086,CK:422.595±108.543 vs.627.216±198.650,CK-MB:70.083±22.982 vs.137.392±24.732).ROC curve showed overall hs-cTnI cut-off value was 0.176 ng/mL in AMI patients,and AUC was 0.940(0.931-0.962);male hs-cTnI cut-off was 0.238 ng/mL,and AUC was 0.943(0.917-0.970);female hs-cTnI cut-off value was 0.130 ng/mL,and AUC was 0.966(0.911-0.992).In age-defined low age group,hs-cTnI cut-off value was 0.152 ng/mL,AUC was 0.954(0.908-0.981),and hs-cTnI cut-off was 0.475 ng/mL,and AUC was 0.993(0.942-1.000)in high age group.The sensitivity of AMI diagnosis was 89.83%,89.86%and 96.12%by using the general,gender and age hs-cTnI cut-off values,respectively,and the specificity was 96.52%,96.55%and 96.55%,the positive predictive value was 96.89%,96.88%and 96.88%,and the negative value was 88.88%,88.89%and 88.19%,respectively.Conclusions Different sex,age-defined hs-cTnI cut-off values are different,and hs-cTnI cut-off values are higher in males than in females,and in high age group than in low age group.We screen out the AMI high-risk people more accurately and avoid misdiagnosis and missed diagnosis by using the cut-off value of hs-cTnI of different populations(gender,age).