彩色多普勒超声联合心肌肌钙蛋白和肌红蛋白检测在急性心肌梗死诊断中的应用价值

Application value of color Doppler ultrasound combined with cardiac troponin and myoglobin in the diagnosis of acute myocardial infarction

目的分析彩色多普勒超声联合心肌肌钙蛋白(cTnI)、肌红蛋白(Mb)在急性心肌梗死诊断中的应用价值。方法选取2019年2月至2022年2月武警河北省总队医院收治的65例急性心肌梗死患者作为观察组,另选取同期63名健康体检者作为常规组。两组均进行彩色多普勒超声检查及cTnI、Mb水平检测,比较两组彩色多普勒超声指标[血流最大峰值流速(Vmax)、阻力指数(RI)]及cTnI、Mb水平,绘制ROC曲线分析彩色多普勒超声指标联合cTnI、Mb水平对急性心肌梗死的诊断价值。结果彩色多普勒超声检出急性心肌梗死59例,检出率为90.77%;漏诊6例,分别为非Q波心肌梗死2例、急性前间壁心肌梗死1例、急性下壁心肌梗死3例。观察组彩色多普勒超声Vmax快于常规组,RI大于常规组,血清cTnI、Mb水平均高于常规组,差异有统计学意义(P<0.05)。ROC曲线分析显示,联合检查、Vmax、RI、cTnI水平、Mb水平诊断急性心肌梗死的AUC分别为0.979(95%CI:0.936~0.998)、0.687(95%CI:0.591~0.754)、0.808(95%CI:0.724~0.895)、0.815(95%CI:0.735~0.888)、0.768(95%CI:0.699~0.836),联合检查的AUC最大,诊断价值最高。结论彩色多普勒超声指标Vmax、RI和血清cTnI、Mb水平对急性心肌梗死均具有一定的诊断价值,但联合诊断价值更高。

Objective To analyze the application value of color Doppler ultrasound combined with cardiac troponin I(cTnI)and myoglobin(Mb)in the diagnosis of acute myocardial infarction.Methods 65 patients with acute myocardial infarction in Hebei Provincial Armed Police Corps Hospital from February 2019 to February 2022 were selected as the observation group,and 63 health checker were selected as the conventional group during the same period.Color Doppler ultrasound examination and cTnI and Mb level detection were performed in the two groups,and and color Doppler ultrasound indexes(maximal peak flow velocity[Vmax],resistance index[RI])and cTnI and Myo levels were compared between the two groups,ROC curve was drawn to analyze the diagnostic value of color Doppler ultrasound index combined with cTnI and Myo levels in acute myocardial infarction.Results 59 cases of acute myocardial infarction were detected by color Doppler ultrasound,the detection rate was 90.77%.The clinical diagnosis of acute myocardial infarction missed by echocardiography were non-Q wave acute myocardial infarction in 2 cases,anterior septal acute myocardial infarction in 1 case and inferior wall acute myocardial infarction in 3 cases.The color Doppler ultrasound Vmax in the observation group was faster than that in the conventional group,RI was greater than that in the conventional group,and serum levels of cTnI and Myo in the observation group were higher than those in the conventional group,and the differences were statistically significant(P<0.05).ROC curve analysis showed that theAUC of combined examination,Vmax,RI,cTnI level and Mb level in the diagnosis of acute myocardial infarction were 0.979(95%CI:0.936-0.998),0.687(95%CI:0.591-0.754),0.808(95%CI:0.724-0.895),0.815(95%CI:0.735-0.888),and 0.768(95%CI:0.699-0.836),the AUC of combined examination was the highest,and the diagnostic value was the highest.Conclusion The color Doppler ultrasound indexes Vmax,RI and serum cTnI and Myo levels have certain diagnostic value for acute myocardial infarction,but the diagnostic value of combined diagnosis is higher.