院外急救中即时检测CK-MB、cTnI和Myo对心肌梗死的早期预测价值临床研究

Predictive value of point-of-care testing of CK-MB,cTnI,and Myo for acute myocardial infarction in emergency treatment

目的评估肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)和肌红蛋白(Myo)对早期诊断急性心肌梗死(AMI)的分析性能。方法研究2019年8月—2020年11月沈阳急救中心接诊疑似AMI急性发作患者共487例。急救医生到现场后,收集患者病历资料、监测心电图及用即时检测(POCT)检测CK-MB、cTnI和Myo。按最终诊断将患者分为AMI组和非AMI组,比较AMI患者和非AMI患者的临床特征以及AMI患者中心肌损伤标志物异常者和心肌损伤标志物正常者的临床特征;以试剂盒给出的参考值为诊断界值时的敏感度、特异度、阴性预测值(NPV)和阳性预测值(PPV)。结果487例胸痛患者中,有169例(34.7%)最终确诊为AMI。AMI患者和非AMI患者的男性所占比例(76.33%vs.60.38%)和心电图异常[Q波异常(67.46%vs.0.31%),ST段异常(67.46%vs.0)]者所占的比例差异均有统计学意义(P<0.05)。AMI患者中,心肌损伤标志物异常者80例。与心肌损伤标志物异常组比较,心肌损伤标志物正常组年龄更轻[(59.44±11.86)岁vs.(64.94±14.45)岁],心电图异常者比例更高[Q波异常(67.46%vs.0.31%),ST段异常(67.46%vs.0)],差异均有统计学意义(P<0.05)。以试剂盒给出的参考值为诊断界值,CK-MB、cTnI和Myo联合检测的灵敏度最高,为47.33%,高于各单项检测、任意两项联检的灵敏度,而单独检测cTnI特异度较高,可达99.37%。结论院外急救患者为胸痛的老年男性患者时,提示AMI的可能性更大。急救院外使用POCT检测CK-MB、Myo、cTnI可以较迅速地对AMI进行初步判断,可以准确地排除AMI。当院外急救胸痛患者的心肌损伤标志物表现正常时,也需要联合心电图结果进行判断。

Objective To evaluate the predictive value of point-of-care testing(POCT)of creatine kinase-MB(CKMB),cardiac troponin I(cTnI),and myoglobin(Myo)in the early diagnosis of acute myocardial infarction(AMI)during emergency treatment.Methods 487 patients with the suspicious diagnosis of AMI,321 males and 166 females,aged(61.71±16.10)(16~95),underwent electrocardiography,and testing of CK-MB,cTnI,and Myo by POCT method at the emergency scen,and then were divided into 2 groups:AMI group(n=169,34.7%)and non-AMI group(n=318,65.3%).The negative predictive value(NPV)and positive predictive value(PPV)of these markers were calculated.with the cutoff value given by the test kit.Results Among the 487 patients with chest pain,169(34.7%)of them were finally diagnosed with AMI.The proportion of males in the AMI group was 76.33%,significantly higher than that of the non-AMI patients(60.38%).The proportion of Q wave abnormality in the AMI group was 67.46%,significantly higher than that in the non-AMI group(0.31%,P<0.05).The proportion of ST segment abnormality in the AMI group was 67.46%,significantly higher than that in the non-AMI group(0,P<0.05).Among the AMI patients,80 of them were found with abnormal levels of myocardial markers.The age of the normal myocardial infarction serum markers group was(59.44±11.86)years old,significantly younger than that of the abnormal myocardial infarction serum markers group[(64.94±14.45)years old,P<0.05].The proportion of pathological Q wave in the abnormal myocardial infarction serum markers group was 58.75%,significantly lower than that in the normal myocardial infarction serum markers group(75.28%,P<0.05),and the proportion of ST segment elevation in the abnormal myocardial infarction serum markers group was 75.00%,significantly lower than that in the normal myocardial infarction serum markers group(94.38,P<0.05).The sensitivity of combo test of CK-MB,cTnI,and Myo was 47.33%,significantly higher than those of every single test and any two combo tests of CK-MB,cTnI and Myo.However,In the single tests,cTnI showed the highest positive predictive value(93.55%),and cTnI+MyO showed the highest negative predictive value(91.83%).Conclusion Elderly male patients with chest pain were more likely to suffer from AMI.The use of POCT to detect CK-MB,cTnI and Myo in the emergency treatment quickly helps make a preliminary diagnosis on AMI,and accurately excludes AMI.When the myocardial infarction serum markers levels of patients with chest pain in the emergency treatment was normal,it is necessary to combine the ECG results for diagnosis.