生化标志物快速检测在急性心肌梗死早期诊断中的应用评价

Evaluation of biochemical markers in early diagnosis of acute myocardial infarction

目的 探讨人肌红蛋白 (Mb)、心肌肌钙蛋白I(CTnI)、肌酸激酶同工酶MB(CK MB)及心肌肌钙蛋白T(CTnT)在急性心肌梗死 (AMI)早期诊断中的应用价值。方法 采用美国TRAGEMETER快速心肌梗死检测仪检测 5 0例高度疑为AMI的患者在发病 2h内的CK MB、CTnI及Mb ,同时标准实验室检测CTnT。结果 5 0例患者中有 2 6例被诊断为AMI。Mb、CTnI、CK MB和CTnT的特异性分别为 95 .83 %、95 .83 %、10 0 .0 0 %和 95 .83 % ,敏感性分别为 10 0 .0 0 %、92 .3 0 %、73 .0 8%和 96.15 % ;阳性预测值分别为 96.3 0 %、96.0 0 %、10 0 .0 0 %和 96.15 % ;阴性预测值分别为 10 0 .0 0 %、92 .0 0 %、77.42 %和 95 .83 %。Mb、CTnI和CTnT的阴性预测值及敏感性均高于CK MB(P <0 .0 5 )。美国TRAGEMETER快速心肌梗死检测仪检测CTnT采样报告时间为 ( 2 0 .0 0± 1.45 )min ,标准实验室检测采样至报告时间为 ( 72 .0 0± 3 .48)min ,两者差异有显著性 (P <0 .0 1) ;快速心肌梗死检测仪检测CTnI和标准实验室检测CTnT ,两者间各项对比差异无显著性 (P >0 .0 5 )。结论 AMI患者发病早期 ( 2h内 ) ,血肌红蛋白和肌钙蛋白的诊断价值高于CK MB ,如此时肌红蛋白和肌钙蛋白检测均为阴性 ,可基本排除AMI。

Objective To appraise the value of cardiac troponin I, cardiac troponin T, CK-MB and myoglobin in early diagnosis of acute myocardial infarction (AMI). Methods 50 consecutive patients in the emergency department were enrolled and evaluated for presence of possible acute myocardial infarction. In these patients, CK-MB, Cardiac Troponin I and myoglobin were detected 2 hours after onset of symptoms. Standard laboratory test of CTnT was performed at the same time. Results The specificitise of myoglobin, CtnI, CK-MB and CTnT 2 hours after onset were 95.83%, 95.83%, 100.00% and 95.83%; the sensitivities were 100.00%, 92.30%, 73.08% and 96.15%; and the positive predictive valueies were 96.30%, 96.00%, 100.00% and 96.15%; the negative predictive values were 100.00%, 92.00%, 77.42% and 95.83% respectively. Statistical analysis of the sensitivities and the negative predictive values for myoglobin, CTnI and CTnT were obviously different from those for CK-MB(P< 0.05). The duration for sampling to report the results by point-of-care device was shorter than that by central laboratory (P<0.01), but the specificity and the sensitivity were not obviously different (P>0.05). Conclusion By using point-of-care device, acute myocardial infarction can be excluded rapidly in the emergency room by measurement of myoglobin and troponin during 0 within 2 hours after onset but can not be excluded just by measurements of CK-MB. The point-of-care device is more useful in those who are suspected to have AMI in emergency room or during hospitalization.