心肌标志物在不稳定型心绞痛和急性心肌梗死的临界值  

Decision limits of myocardial markers in acute myocardial infarction and unstable angina pectoris

作　　者：黄冰生 董吁钢[2] 陈丹丹[2] 谢桂琳[2] 殷然[2] 程颖 

机构地区：[1]广州市番禺何贤纪念医院心内科,广州510000 [2]中山大学附属第一医院心内科,广州510080

出　　处：《岭南心血管病杂志》2005年第5期324-327,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨不稳定型心绞痛和急性心肌梗死心肌标志物的临界值。方法测定不稳定型心绞痛34例和急性心肌梗死病人64例在发病后5日内多时间点的血清心肌标志物浓度,包括心肌肌钙蛋白、肌酸激酶同工酶MB质量和活性、肌红蛋白、肌酸激酶、天冬氨酸转氨酶和乳酸脱氢酶活性,并通过时量曲线分析心肌标志物诊断急性心肌梗死的临界值。结果34例不稳定型心绞痛病人中仅有7例心肌标志物不同程度升高;而在急性心肌梗死病人,心肌肌钙蛋白、肌酸激酶同工酶MB和肌红蛋白的峰值分别为24,16,8小时。其诊断急性心肌梗死临界峰值分别为0.25,16.6,75.6μg/L。结论诊断区分急性心肌梗死和不稳定型心绞痛的心肌标志物的临界值为心肌肌钙蛋白0.25μg/L,肌酸激酶同工酶MB为16.6μg/L,肌红蛋白为75.6μg/L。Objectives To investigate the AMI decision limits of myocardial markers by ROC curves. Methods The serum cTnT, CK-MB and CK-MB mass,Myo,CK,AST and LDH were measured in 64 AMI and 34 unstable angina pectoris patients. The measurements were done 4 hours to 5 days after AMI. ROC curves were used to evaluate these myocardial markers in AMI. Results The myocardial markers were elevated in 7 patients in 34 unstable angina pectoris patients. The time of the top values of cTnT, CK-MB mass and Myo was 24 h, 16 h and 8 h respectively in AMI patients. The cutoff values of the top values of cTnT,CK-MB mass and Myo were 0.25 μg/L, 16.6 μg/L and 75.6 μg/L respectively by ROC curve. Conclusions cTnT≥ 0.25 μg/L, CK-MB mass ≥16.6 μg/L or Myo≥75.6 μg/L would support the diagnosis of AMI. But cTnT 〈 0.25 μg/L,CK-MB mass 〈 16.6 μg/L or Myo 〈 75.6 μg/L would support the diagnosis of unstable angina pectoris.

关 键 词：心肌肌钙蛋白 肌酸激酶同工酶 肌红蛋白 急性心肌梗死 不稳定型心绞痛 

分 类 号：R542.22[医药卫生—心血管疾病]