心肌损伤标志物对心肌梗死与心绞痛的鉴别诊断效率评价  

Efficiency of differential diagnosis of myocardial injury markers in acute myocardial infarction(AMI)and angina pectoris 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,北京100101

出　　处：《中国实用内科杂志》2006年第10期1510-1513,共4页Chinese Journal of Practical Internal Medicine

摘　　要：目的评价几种心肌损伤标志物用于急性心肌梗死(AMI)与心绞痛的鉴别诊断效率。方法选择解放军第306医院2002年11月至2004年11月收治的住院患者188例,其中AMI组92例,心绞痛组96例。肌钙蛋白I(TnI)和肌红蛋白(Myo)测定用化学发光法,肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH)用酶动力连续监测法,超敏C-反应蛋白(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。结果AMI发生≤6h的ROC曲线下的面积依次为Myo0·92、TnI0·92、CK0·81、CK-MB0·81、AST0·78、hs-CRP0·73、LDH0·70、HBDH0·65;AMI发生>6h依次为TnI0·93、AST0·86、CK-MB0·84、CK0·80、Myo0·76、HBDH0·72、LDH0·70、hs-CRP0·56;AMI发生≤6h的敏感性和特异性TnI0·87和0·90、Myo0·96和0·78、CK0·83和0·67、CK-MB0·65和0·82、AST0·69和0·77、LDH0·64和0·73、HBDH0·71和0·65、hs-CRP0·64和0·82。阳性似然比最高为TnI8·8,阴性似然比最低为Myo0·05。结论AMI与心绞痛鉴别诊断效率依次为TnI、Myo、CK-MB、CK;Myo在AMI发作6h以后的诊断效率降低,AST、LDH、HBDH仍有意义。Objective To study the diagnostic efficiency of myocardial markers, TnI, Myo, CK, CK - MB 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） by Receiver Operating Characteristic （ROC）. Results When the interval between heart accident onset and blood sampled was no more than 6 hours, area under curve （AUC） of eachmarkerswas： Myo0.92, Tni0.92, CK0.81, CK-MB0.81, AST0.78, hs-CRP 0.73, LDH 0.70, HBDH 0. 65. When the interval was more than 6 hours, AUC was TnI 0. 93, AST 0. 86, CK - MB 0. 84, CK 0. 80, Myo 0. 76, HBDH 0. 72, LDH 0. 70, 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, CK - MB0.65 and0.82, AST 0. 69 and 0. 77, LDH0.64 and0.73, HBDH0.71 and0.65, hs-CRP0. 64 and0.82, respectively, cTnI had the highest positive likelihood ratio 8.8, however, Myo had the lowest negative likelihood ratio 0. 05. Conclusion The efficiency of myocardiac markers in differential diagnosis between AMI and angina pectoris is TnI 〉 Myo 〉 CK - MB 〉 CK. Efficiency of Myo decreases apparently after heart accident onset is more than 6 hours. Traditional marker, CK, CK - MB, AST, LDH and HBDH still have some efficiency in AMI diagnosis.

关 键 词：心肌梗死 受试者操作特性曲线 心肌损伤标志物 心绞痛 

分 类 号：R5[医药卫生—内科学]