采用受试者操作特性曲线评价心肌损伤标志物对急性心肌梗死的诊断价值  

Evaluation of differential diagnosis of AMI with angina pectoris using myocardial injury markers by ROC analysis

作　　者：敬华[1] 李丹[1] 王晓非[1] 陈兴明[1] 高铁山[1] 魏萍[1] 

机构地区：[1]解放军第306医院,北京市100101

出　　处：《总装备部医学学报》2006年第3期135-138,共4页Medical Journal of General Equipment Headquarters

摘　　要：目的评价肌钙蛋白I(TnI)、肌红蛋白(Myo)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、超敏C-反应蛋白(hs-CRP)、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH),用于急性心肌梗死(AMI)和心绞痛的鉴别诊断效率。方法AMI组92例,心绞痛组96例。TnI和Myo测定用化学发光法,CK、CKMB、AST、LDH、HBDH用酶动力连续监测法,hs-CRP用增强胶乳免疫浊度法。采用受试者操作特性曲线(ROC)分析曲线下面积和敏感度、特异性等评价指标。结果AMI发生<6 h的ROC曲线下面积依次为Myo 0.92、TnI 0.92、CK 0.81、CKMB 0.81、AST0.78h、s-CRP 0.73、LDH 0.70、HBDH 0.65;AMI发生>6 h依次为TnI 0.93、AST 0.86、CKMB0.84、CK 0.80、Myo 0.76、HBDH 0.72、LDH 0.70h、s-CRP 0.56;AMI发生<6 h的敏感性和特异性分别为TnI 0.87和0.90、Myo 0.96和0.78、CK 0.83和0.67、CKMB 0.65和0.82、AST 0.69和0.77、LDH 0.64和0.73、HBDH 0.71和0.65、hs-CRP 0.64和0.82。阳性似然比最高为TnI 8.8,阴性似然比最低为Myo 0.05。结论诊断AMI效率较高的项目依次为TnI、Myo、CKMB、CK,Myo在AMI发作6 h以后的诊断效率降低,AST、LDH、HBDH仍有诊断意义。Objective To study the diagnostic efficiency of myocardial markers,TnI,Myo,CK,CKMB and hs-CRP etc in differential diagnosis of AMI with angina pectoris.Methods The myocardial markers were qualified and compared with each other in AMI patients(n=92) and angina patients(n=96).Results When the interval between heart accident onset and blood sampled was no more than 6 hours,the area under curve(AUC) of each markers was Myo 0.92,Tn 10.92,CK 0.81,CKMB 0.81,AST 0.78,hs-CRP 0.73,LDH 0.70 and HBDH 0.65,respectively.When the interval was more than 6 hours,AUC was Tnl 0.93,AST 0.86,CKMB 0.84,CK 0.80,Myo 0.76,HBDH 0.72,LDH 0.70 and hs-CRP 0.56,respectively.The sensitivity and specificity of differential diagnosis of AMI with angina was TnI 0.87 and 0.90, Myo 0.96 and 0.78,CK 0.83 and 0.67,CKMB 0.65 and 0.82,AST 0.69 and 0.77,LDH 0.64 and 0.73,HBDH 0.71 and 0.65,and hs-CRP 0.64 and 0.82,respectively.cTnI had the highest positive likelihood ratio 8.8,while Myo had the lowest negative likelihood ratio 0.05.Conclusions The efficiency of myocardiac markers in differential diagnosis of AMI with angina pectoris is TnI > Myo > CKMB > CK.Efficiency of Myo decreases apparently,especially when the interval is more than 6 hours.Traditional markers such as CK,CKMB, AST,LDH and HBDH still have some efficiency in AMI diagnosis.

关 键 词：受试者操作特性曲线 心肌损伤标志物 急性心肌梗死 心绞痛 

分 类 号：R542.22[医药卫生—心血管疾病]