The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/contemporary cardiac troponin for the early diagnosis of acute myocardial infarction

BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)assays in AMI diagnosis.METHODS:This multicenter,observational study included 3,706 patients with acute chest pain from September 1,2015,to September 30,2017.We classified the participants into three groups according to the c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn increased the diagnostic sensitivity of AMI(56.1%vs.63.9%,P<0.001;82.7%vs.84.3%,P=0.025).In contrast,combining CK-MB and hs-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn alone(72.8%vs.75.0%,P=0.046),while the sensitivity did not increase with time from symptom onset>6 h(97.5%vs.98.3%,P=0.317).The AUC of the combination of CK-MB and POC-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.

Comparison of plasma microRNA-1 and cardiac troponin T in early diagnosis of patients with acute myocardial infarction

BACKGROUND:Early reperfusion can effectively treat acute myocardial infarction(AMI) and reduce the mortality signif icantly. This study aimed to compare the role of plasma microRNA-1(miR-1) and cardiac troponin T(cTnT) in early diagnosis of AMI patients.METHODS:From May 2011 to May 2012,plasma samples were collected from 56 AMI patients and 28 non-AMI controls. The expression of plasma miR-1 was measured by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),and the level of plasma cTnT was measured using electrochemiluminescence-based methods on an Elecsys 2010 Immunoassay Analyzer. SPSS 16.0 was used for the statistical analysis of the results. Data were expressed as mean±standard deviation unless otherwise described. The differences about clinical characteristics between the AMI patients and controls were tested using Student's t test or Fisher's exact test. The Mann-Whitney U test was conducted to compare the expression of microRNAs between the AMI patients and controls. MicroRNAs expression between different intervals of the AMI patients was compared using Wilcoxon's signed-rank test. The receiver operating characteristic(ROC) curve was established to discriminate the AMI patients from the controls.RESULTS:In the present study,the expression of plasma miR-1 was signifi cantly increased in the AMI patients compared with the healthy controls(P<0.01). The plasma miR-1 in the AMI patients decreased to the normal level at 14 days(P>0.05). The expression of plasma miR-1 was not related to the clinical characteristics of the study population(P>0.05). ROC curve analyses demonstrated that miR-1 was specifi c and sensitive for the early diagnosis of AMI,but not superior to cTnT.CONCLUSION:Plasma miR-1 could be used in the early diagnosis of AMI,but it is similar to cTnT.

The influence of tirofiban on the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI

Objective:To observe the influence of tirofiban on the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI and provide scientific basis for treatment of acute myocardial infarction.Methods:A total of 100 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: the control group (50 cases) and the observation group (50 cases). The conventional treatment of PCI was performed on both groups. Tirofiban injection was given to the observation group on the basis of conventional treatment. cTnI, BNP and echocardiography parameters (LVEF, LVEDD, LVESD) were detected before and after treatment.Results:The comparison of cTnI in the two groups before operation was not statistically significant. cTnI in the 2 groups increased 12 h and 24 h after operation. But the cTnI in observation group (0.10±0.23) ng/mL decreased more significantly than that in control group (0.24±0.31) ng/mL, the difference was considered to be statistically significant. The comparison of BNP in the two groups before operation was not statistically significant. BNP in the 2 groups decreased obviously 7 d and 30 d after operation. BNP in observation group decreased more significantly than that in control group and the difference was considered to be statistically significant LVEF in the observation group increased significantly compared with that in control group 7 d after operation. The comparison of LVEDD, LVESD were not considered to be statistically significant. LVEDD and LVESD in the observation group were lower than that in control group obviously 30 d after operation. While the LVEF in the observation group was still higher than that in the control group. The comparsion was considered to be statistically significant.Conclusion:Tirofiban can improve the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI. It can also decrease the heart injury as well as helping the recovery of heart function.

Risk Stratification with Serum Cardiac Troponin I in Acute Myocardial Infarction on Admission

Objective To assess the prognostic significance of serum cardiac troponin I (cTnI) concentration in patients with acute myocardial infarction on admission. Methods Serum samples of 108 patients with established AMI were collected on admission for measuring cTnI and were grouped according to the intervals between the onset of chest pain and admission. Results In each of these groups, the serum cTnI concentrations in patients died after admission were significantly higher than those who survived (all P<0.05). Conclusions A higher serum cTnI concentration on admission in patients with AMI was associated with an increased risk of subsequent cardiac death during hospitalization.

Penetrating Atherosclerotic Ulcer with Elevated Troponin in A Patient with Old Myocardial Infarction: A Case Report

Penetrating atherosclerotic ulcer(PAU),an uncommon etiology of acute aortic syndrome(AAS),is a potential cause of chest pain seen in emergency departments.As PAU may lead to electrocardiogram(ECG)changes or rarely,elevated troponin levels,it is most likely misdiagnosed as acute coronary syndrome(ACS).Hence,individuals with PAU may be offered potentially life-threatening treatment.This paper reports a case of a 81-year-old male who presented with intermittent chest pain with a history of old inferior myocardial infarction and stent placement in the left circumflex coronary artery(LCX)three years ago.Initially,he was diagnosed with non-ST-elevation myocardial infarction(NSTEMI)based on abnormal ECG changes and raised troponin I.However,emergency coronary angiography(CAG)showed no restenosis in the left circumflex coronary artery(LCX)but with mild stenosis in the left anterior descending artery(LAD)and right coronary artery(RCA).Computed tomographic angiography(CIA)of the whole aorta showed multiple atherosclerotic plaques with penetrating atherosclerotic ulcer in the aortic arch and descending aorta.Endovascular aortic repair with Ankura II covered stent was performed.This case study reminds us that it is clinically difficult to distinguish PAU from ACS.Upon excluding ACS from the diagnosis,we should take into consideration of PAU,especially in elderly patients with positive cTnI.

Characteristics of elevated cardiac troponin I in patients with acute ischemic stroke

Objective To study prognostic characteristics of cardiac troponin I （cTnI） elevation in acute ischemic stroke. Methods We retrospectively studied patients （n = 248） with acute ischemic stroke, acute ST-segment elevation myocardial infarction, and acute non-ST-elevation myocardial infarction who were treated between January 2013 and October 2015. Baseline demographic data and changes in cTnI levels among these three groups were compared. Patients with acute ischemic stroke were assigned to either the cTnI elevation group （cTnI 〉 0.034 ng/mL） or the no cTnI elevation group （cTnI ≤ 0.034 ng/mL）. Logistic regression analysis was used to identify risk factors associated with elevated serum cTnI in patients with acute ischemic stroke. Moreover, the duration of hospital stay and incidence of major cardiovascular outcomes were compared in patients with acute ischemic stroke, with or without elevated cTnI. Results In this study population of patients with acute ischemic stroke （n = 178）, acute ST-segment elevation myocardial infarction （n = 35）, and acute non-ST-elevation myocardial infarction （n = 35）, patients with acute ischemic stroke with elevated cTnI comprised 18.54% of subjects. Patients with elevated cTnI were older and more likely to have a history of hypertension. In addition, these patients had higher levels of inflammatory markers, reduced renal functions, increased D-dimer levels, higher NIH stroke scores, and lower left ventricular ejection fractions. Logistic regression analysis showed that both percentage of neutrophil and NIH stroke scores were elevated; estimated glomerular filtration rate and left ventricular ejection fraction were decreased in patients with acute ischemic stroke who had elevated cTnI, and they had more frequent major cardiovascular events during hospital stay. Conclusion Elevated cTnI detected in patients with acute ischemic stroke, indicated a greater likelihood of poor short-term prognosis during hospital stay.

EVALUATION OF SERUM TROPONIN T MEASUREMENTIN ACUTE MYOCARDIAL INFARCTION

The release kinetics of the cardiac specific troponin T (cTnT), measured by an immunosorbent assay, in 32 patients with acute myocardial infarction (AMI) was evaluated. In 8 AMI patients (25%), the release kinetics of serum cTnT showed biphasic serum concentration curves with a large peak at 10 to 18 hours after onset and the serum cTnT concentrations were up to 30 to 120 times of the normal upper limit-detected (0.2 μg / ml), and another samll cTnT peak at 70 to 100 hours after onset of pain. The serum cTnT measurements in the remaining 24 AMI patients (75%) gave only one large peak which was around 32 to 108 hours after onset of pain. cTnT appeared in serum as early as 3 to 4 hours and remained elevated until 240 hours after the infarctions. The results indicated that (1) cTnT was a sensitive and specific marker of AMI; (2) the biphasic curve of cTnT releae in general, the ratio of cTnT at around 14 to 32 (14/32)>1 in particular, may be a useful marker suggesting early reperfusion; (3) the continuous elevation of serum cTnT in AMI course might be a prognostic indicator for unfavorable outcomes.

Chest pain and troponin elevation in a Duchenne Muscular Dystrophy:Acute myocardial infarction or progres-sion of Duchenne cardiomyopathy

Duchenne Muscular Dystrophy （DMD） is an X- linked disorder and presents in boys of early childhood with proximal muscle weak- ness, calf hypertrophy and markedly elevated creatine kinase levels. Weakness in DMD is progressive, and ambulation is lost early in the second decade1. The main clinical features of the patients are the proximal muscle weakness and atrophy, unusual walking posture,

肌酸激酶同工酶MB、肌钙蛋白Ⅰ、氨基末端脑钠肽前体对非ST段抬高心肌梗死的诊断价值

目的探讨肌酸激酶同工酶MB(CK-MB)、肌钙蛋白Ⅰ(cTnI)、氨基末端脑钠肽前体(NT-pro BNP)对非ST段抬高心肌梗死的诊断价值。方法选取江苏省如皋市人民医院2020年6月至2022年1月收治的120例非ST段抬高心肌梗死患者作为观察组,另选取同期120例不稳定型心绞痛患者作为对照组。观察非ST段抬高心肌梗死患者的心电图特征;比较两组CK-MB、cTnI和NT-pro BNP水平;分析非ST段抬高心肌梗死发生的影响因素;采用受试者操作特征曲线分析CK-MB、cTnI、NT-pro BNP诊断非ST段抬高心肌梗死的诊断效能。结果120例非ST段抬高心肌梗死患者中,ST段持续压低53例、ST段压低动态衍变67例。观察组血清CK-MB、cTnI、NT-pro BNP水平高于对照组(P<0.05)。CK-MB、cTnI及NT-pro BNP是发生非ST段抬高心肌梗死的危险因素(OR=3.515、4.683、3.577,P<0.05)。CK-MB、cTnI、NT-pro BNP单一及联合诊断非ST段抬高心肌梗死的曲线下面积分别为0.750(95%CI:0.649~0.851)、0.748(95%CI:0.649~0.847)、0.731(95%CI:0.631~0.832)、0.827(95%CI:0.739~0.915)。结论CK-MB、cTnI、NT-pro BNP可用于辅助诊断非ST段抬高心肌梗死,且诊断效能较高。

NLR、胱抑素C、超敏肌钙蛋白Ⅰ对不同年龄段急性心肌梗死并发症的预测价值

目的:探讨不同年龄段急性心肌梗死(AMI)实验室指标并发症的临床价值。方法:选取2021年1月—2022年1月于江苏省中医院就诊的AMI病人162例,将病人分为中青年组(18~74岁)86例,老年组(75~99岁)76例。收集病人临床资料和实验室指标。根据是否合并心力衰竭、心源性休克、心律失常等并发症将中青年组、老年组分为并发症组及无并发症组,其中中青年并发症组53例,中青年无并发症组33例;老年并发症组46例,老年无并发症组30例。采用受试者工作特征(ROC)曲线评估相关指标对AMI病人并发症的预测价值。结果:中青年组男性比例、吸烟史比例、总胆固醇(TC)、三酰甘油(TG)高于老年组,糖化血红蛋白(HbA1c)低于老年组,差异均有统计学意义(P<0.05)。中青年并发症组胱抑素C(CysC)、超敏肌钙蛋白I(hs-TnI)、中性粒细胞/淋巴细胞比值(NLR)、中性粒细胞(Neu)、白细胞计数(WBC)高于中青年无并发症组,淋巴细胞(Lym)低于中青年无并发症组,差异有统计学意义(P<0.001)。老年并发症组CysC、hs-TnI、NLR、Neu、WBC、TG水平高于老年无并发症组,Lym低于老年无并发症组,差异有统计学意义(P<0.05)。中青年组CysC、hs-TnI、NLR、Neu的ROC曲线下面积(AUC)分别为0.74,0.85,0.83,0.82;老年组CysC、hs-TnI、NLR的AUC分别为0.75,0.77,0.79。结论:不同年龄段AMI病人生活方式、实验室指标均存在差异,对AMI病人诊疗时需考虑年龄因素及生理特点;CysC、hs-TnI、NLR、Neu等实验室指标可较好地预测AMI病人并发症。

急性心肌梗死患者血清心脏肌钙蛋白Ⅰ的浓度与心肌梗死范围的研究

目的通过检测急性心肌梗死(AMI)患者血清心脏肌钙蛋白I(cTnI)的浓度评估心肌梗死范围及预后。方法用酶联免疫吸附法(ELISA)检测患者血清cTnI的浓度,同时观察患者病情变化。结果大范围心肌梗死组,中等范围心肌梗死组和小范围心肌梗死组3组血清cTnI浓度分别为(3.80±0.21)ng/L、(3.27±0.20)ng/L和(3.04±0.15)ng/L。大范围心肌梗死组显著高于中等范围心肌梗死组(P<0.01),中等范围心肌梗死组显著高于小范围心肌梗死组(P<0.01)。大范围心肌梗死组,中等范围心肌梗死组和小范围心肌梗死组三组血清cTnI浓度下降至<0.15ng/L所需天数分别为(7.36±1.30)d、(6.42±0.64)d和(6.30±0.78)d。大范围心肌梗死组所需天数显著多于中等范围心肌梗死组(P<0.05)和小范围心肌梗死组(P<0.05)。而中等范围心肌梗死组和小范围心肌梗死组比较差异无统计学意义(P>0.05)。结论血清cTnI对诊断AMI具有高度敏感及高度特异性,cTnI浓度可作为判断AMI时梗死范围和疗程长短的参考指标。

心脏肌钙蛋白Ⅰ与肌红蛋白比值诊断急性心肌梗死

目的研究心脏肌钙蛋白Ⅰ/肌红蛋白比值在诊断急性心肌梗死中的价值。方法选择2006年1月1日-2008年12月31日在苏州大学附属第一医院行肌红蛋白和肌钙蛋白检测的患者1075例,采用回归分析研究肌钙蛋白,肌钙/肌红蛋白比值以及肌红蛋白诊断急性心肌梗死的价值。接受者工作特征曲线(ROC)分析上述3个指标诊断急性心肌梗死临床界值。结果 Logistic回归分析表明,肌红蛋白的估计值为0.00106,标准误为0.000293,卡方值为13.0451,P值为0.0003,标准偏回归系数为0.1731;肌钙蛋白的估计值为0.0994,标准误为0.0194,卡方值为26.3095,P<0.0001,标准偏回归系数为1.9595;肌钙/肌红蛋白的估计值为4.7482,标准误为1.2454,卡方值为14.5367,P值为0.0001,标准偏回归系数为0.7561。ROC分析表明,肌钙蛋白曲线下面积(AUC)为0.918,95%可信区间0.898～0.936,P值为0.0001,界值为0.21;灵敏度为96.32%,95%可信区间为93.3%～98.2%;特异度为77.45%,95%可信区间为73.8%～80.8%。肌红蛋白AUC为0.635,95%可信区间为0.602～0.668,P值为0.0001,界值为112;灵敏度为51.47%,95%CI为45.4%～57.5%;特异度为71.26%,95%可信区间为67.4%～74.9%。肌钙/肌红蛋白比值AUC为0.815,95%可信区间0.787～0.840,P值为0.0001,界值为0.0112;灵敏度为72.79%,95%可信区间为67.1%～78.0%;特异度为82.79%,95%可信区间为79.5%～85.8%。ROC分析结果表明,两两相比肌钙蛋白诊断效能优于肌钙/肌红蛋白比值,而肌钙/肌红蛋白比值又优于肌红蛋白,差异均有统计学意义(P<0.05)。结论心脏肌钙蛋白/肌红蛋白比值是诊断急性心肌梗死的又一个有意义的指标。

纤维蛋白原、内皮素、P-选择素及肌钙蛋白Ⅰ测定在急性冠脉综合征诊断中的价值

目的 判断纤维蛋白原(Fg)、内皮素(ET-1)、P-选择素和肌钙蛋白Ⅰ(cTnI)对急性心肌梗死(AMI)和不稳定型心绞痛(UA)的诊断价值。方法 用Beckmun全自动生化仪测定Fg,放射免疫法测定ET-1,流式细胞术测定P-选择素,Access化学发光法测定cTnI,共测定23例AMI患者,21例UA患者和28例健康对照者。结果 3组被检者的Fg、ET-1、P-选择素及cTnI的含量均值间差别均有非常显著性意义(P<0.01);UA组与AMI组患者的P选择素、cTnI的含量间差别有显著性意义(P<0.05),而Fg、ET-1的含量间差别无显著性意义(P>0.05);AMI组与对照组被检者的Fg、ET-1、P-选择素,cTnI的含量间差别均有显著性意义(P<0.05);UA组与对照组被检者的Fg、ET-1、P-选择素的含量间差别亦有显著性意义(P<0.05),而cTnI含量间差别无显著性意义(P>0.05)。多元回归分析发现P-选择素与cTnI含量间存在一定的相关关系(r=0.404,P<0.01)。判断分析发现同时测定Fg、ET-1、P-选择素及cTnI可预测患者属于AMI、UA和对照组的正确性为86.7％。结论 Fg、ET-1、P-选择素是检测血栓前状态的敏感指标,Fg、ET-1、P-选择素和cTnI同时测定可预测急性冠脉综合征的发生。

血清心肌肌钙蛋白Ⅰ光激化学发光免疫测定法的建立

目的采用光激化学发光免疫测定法(LICLIA)建立血清心肌肌钙蛋白I(cTnI)的定量检测方法。方法使用2株特异性的cTnI单克隆抗体,一株包被发光微粒,另一株进行生物素化,与包被有链霉亲合素的感光微粒共同构成检测试剂,优化检测条件并评价检测性能。结果方法的分析灵敏度为0.05 ng/mL,在1.10～29.36 ng/mL范围内线性良好。批内和日间变异系数(CV)分别为4.89%～5.93%和6.76%～8.96%。cTnI浓度为161 ng/mL时方法无Hook效应。与Biocheck cTnI酶联免疫吸附试验(ELISA)具有较好的相关性(r=0.964)。结论血清cTnI的LICLIA定量检测方法的建立有助于急性心肌梗死诊断试剂盒的研制。

脑钠肽、肌红蛋白及肌钙蛋白Ⅰ联合测定对早期诊断急性心肌梗死的临床意义

目的探讨急性心肌梗死(AMI)患者血浆脑钠肽(BNP),血清肌红蛋白(MYO),肌钙蛋白I(cTnI)的浓度变化及三者间的相关性,以探讨其对AMI的临床意义。方法采用化学免疫荧光法定量检测47例AMI患者入院后24 h内的BNP,MYO和cTnⅠ,并进行比较分析单个测定以及联合测定时诊断AMI的敏感性和特异性。结果 (1)AMI组BNP,MYO及cTnI的结果与健康对照组相比较,均有显著升高(P<0.05)。(2)在胸痛发作后2～6 h BNP,MYO,cTnI以及三项联合检测敏感性分别为76.2%,62.1%,74.2%,93.5%和特异性分别为79.2%,63.5%,82.7%,77.9%;在胸痛发作后6～12 h BNP,MYO,cTnI以及三项联合检测敏感性分别为89.5%,67.8%,83.5%,95.9%和特异性分别为84.3%,62.1%,88.3%,80.6%;在胸痛发作后12～24 h BNP,MYO,cTnI以及三项联合检测敏感性分别为94.7%,85.9%,92.6%,98.5%和特异性分别为97.6%,59.4%,96.5%,83.1%。结论 BNP,MYO及CTnI联合检测可以提高AMI检测的敏感性,有助于AMI早期诊断。

心脏肌钙蛋白Ⅰ在急性心肌梗死中的临床意义

目的 :探讨心脏肌钙蛋白 (c Tn )在急性心肌梗死 (AMI)中的临床意义。方法 :6 0例 AMI,其中 Q波型 AMI42例 ,非 Q波型 AMI18例 ,分别于入院即刻、 2 4小时、 72小时、 7天抽血 ,测定 c Tn 、CK- MB,随访半年。结果 :(1) c Tn 阳性率在 AMI即刻、 2 4小时、 72小时、 7天的 Q波型 AMI和非 Q波型 AMI依次分别为2 3.8% ,10 0 % ,90 .48% ,2 6 .19% ;11.11% ,77.78% ,5 5 .5 6 % ,16 .6 1%。Q波型 AMI的 c Tn 水平明显依次高于 CK- MB的 11.9%、 90 .48%、 11.97%、 0 % ;(2 )第 7天持续阳性的 14例中 ,4例死于心脏骤停 ,5例发生心衰 ,5例发生心绞痛。结论 :(1) AMI后 2 4小时 c Tn 阳性率高于 CK- MB;(2 ) c Tn

急性冠状动脉综合征患者N末端B型钠尿肽前体和肌钙蛋白Ⅰ水平与冠状动脉病变的关系

目的探讨急性冠状动脉综合征患者血清N末端B型钠尿肽前体(NT-proBNP)和肌钙蛋白I(cTnI)含量与冠状动脉病变程度的关系。方法选择急性冠状动脉综合征患者98例,分为急性ST段抬高心肌梗死(STEMI)组46例,急性非ST段抬高心肌梗死(NSTEMI)组16例,不稳定性心绞痛(UAP)组36例,均于入院时或发病24 h内测定患者血清NT-proBNP、cTnI含量,冠状动脉造影了解冠状动脉病变情况,并行心脏彩色多普勒超声检测,以评估患者的心功能。结果与UAP组比较,STEMI组和NSTEMI组NT-proBNP明显升高;与NSTEMI组比较,STEMI组cTnI明显升高(P<0.05)。NT-proBNP与冠状动脉病变积分呈正相关(r=0.156,P<0.05),与LVEF呈负相关(r=-0.196,P<0.01);cTnI与冠状动脉病变积分呈正相关(r=0.247,P<0.01)。结论急性冠状动脉综合征患者NT-proBNP与cTnI无关,但两者均可反映冠状动脉病变的严重程度。NT-proBNP的高低能反映患者的心功能状态,cTnI则与心功能无关。

肌钙蛋白Ⅰ与肌红蛋白定时定量监测在急性心肌梗死诊疗过程中的临床观察

根据心肌肌钙蛋白Ⅰ(cTnI)与肌红蛋白(Mb)在急性心肌梗死(AMI)发生后的定时定量分析结果比较,为AMI的早期诊断提供更灵敏、更准确的监测指标。本文采集95例AMI患者于胸痛发作0～4h、8h、12h、24h、48h、3天、5天和7天的血清,以及对照组38名的空腹血清同步进行cTnI与Mb的动态检测和比较,结果发现,AMI患者的早期0～4h Mb的灵敏度明显高于cTnI;而8h后cTnI的灵敏度和准确度明显高于Mb。

超敏肌钙蛋白Ⅰ在急诊胸痛患者急性心肌梗死早期预测中的价值

目的探讨超敏肌钙蛋白I(hs-cTnI)的动态变化,明确不同时间点的诊断截点及变化范围,为早期诊断急性心肌梗死(AMI)提供有效预测工具。方法纳入2016年11月～2017年12月就诊于上海中医药大学附属普陀医院的急诊胸痛患者142例,最终诊断为AMI患者75例,不稳定性心绞痛(UA)患者37例,并选择同期健康体检者30名作为健康对照组。采用直接化学发光免疫分析法检测三组患者入院即刻(T_0)、入院3 h(T_3)的血清hs-cTnI值,并计算T_3-T_0 hs-cTnI的绝对变化值及其hs-cTnI的变化斜率(△hs-cTnI)。根据受试者工作特征曲线(ROC)及Youden指数判断不同时间点的最佳诊断截点及最佳变化范围。结果①急诊胸痛患者胸痛症状明显改善,(T_0)hs-cTnI≥0.04 ng/mL,(T_3)hs-cTnI≥0.48 ng/mL [AUC:0.994,最佳截断值:0.48 ng/mL]或T_3-T_0 hs-cTnI绝对变化值≥0.45 ng/mL [AUC:0.952,最佳截断值:0.45 ng/mL],诊断AMI价值较大;②如果胸痛症状持续不能改善,T3-T0 hs-cTnI绝对变化值≥1.001 ng/mL [AUC:0.945,最佳截断值:1.001 ng/mL],诊断AMI价值较大;③而对于只有一过性胸痛症状发生,(T_0)hs-cTnI≥0.05 ng/mL [AUC:0.483,最佳截断值:0.05 ng/mL],随访3 h hs-cTnI绝对变化值下降≥0.015ng/mL[AUC:0.686,最佳截断值:-0.015 ng/mL],诊断UA价值大。④AMI组△hs-cTnI较UA组明显升高(P<0.01)。结论单独使用(T_0)及(T_3)hs-cTnI不能有效诊断AMI,使用hs-cTnI单点诊断数值(T_0或T_3)结合hs-cTnI绝对变化值诊断AMI有效性较高。