白细胞分类与肌酸磷酸激酶同工酶检测结合对急性心肌梗死的早期诊断价值

White Blood Cell Count and Creatine Kinase Isoenzymes in the Early Diagnosis of Acute Myocardial Infarction

目的 观察白细胞分类与肌酸磷酸激酶同工酶 (CK MB)检测相结合对急性心肌梗死的早期诊断价值。方法 前瞻性研究因胸痛而就诊的病例 6 2 5例 ,观测心电图变化及血液肌酸磷酸激酶及其同工酶 ,白细胞总数及分类 ,肌钙蛋白T等的变化 ,最后统计并比较各指标尤其是白细胞分类并肌酸磷酸激酶同工酶对急性心肌梗死的早期诊断价值。结果 急性心肌梗死胸痛发生后 1 2h内相对淋巴细胞减少的敏感性最高 (6 1 3% ) ;肌酸磷酸激酶同工酶并白细胞分类对急性心肌梗死诊断的特异性和诊断有效性 ,与心电图有诊断意义的ST段抬高相近 ,而敏感性明显高于后者 (4 6 8%vs 38 7% ,P <0 0 5 )。结论 肌酸磷酸激酶同工酶与白细胞分类两个指标相结合 ,敏感性和特异性均较高 。

Objective To evaluate the use of white blood cell count and MB isoenzyme of creatine kinase (CK MB) for early diagnosis of acute myocardial infarction (AMI).Methods 625 cases admitted for chest pain were prospectively studied. Their change of ECG, serum creatine kinase and its isoenzymes, the white blood cell count, and troponin T were statistically analyzed. The importance of the above parameters especially the white blood cell count and creatine kinase and its isoenzymes for early diagnosis of AMI was evaluated. Results The relative lymphopenia in 12 hours after onset of chest pain has the highest correlation with AMI, that is 61 3%. The specificity and effeciency of using creatine kinase isoenzymes measurement and white blood cell characterization for the diagnosis of AMI is similar to that of using ECG, while the sensitivity of the former is obviously higher than the latter (46 8% vs 38 7%, P <0 05).Conclusions Combination of isoenzymes of creatine kinase measurement and white blood cell count is likely the best clinical parameter for the early diagnosis of AMI.