联合检测cTnI、MYO和CK-MB mass对病毒性心肌炎诊断的评价  

Diagnostic evaluation of viral myocarditis by combined determination of cTnI,MYO and CK-MB mass

作　　者：刘成桂[1] 谢国明[1] 郑军[1] 张钢[2] 

机构地区：[1]重庆医科大学检验系,重庆400016 [2]第三军医大学高原军事医学系

出　　处：《解放军医学杂志》2007年第9期976-978,共3页Medical Journal of Chinese People's Liberation Army

基　　金：重庆市自然科学基金资助项目(CSTC2006BB5272)

摘　　要：目的探讨联合检测心肌肌钙蛋白(cTnI)、肌红蛋白(MYO)和肌酸激酶同工酶MB质量(CK-MB mass)对病毒性心肌炎(VMC)的诊断价值。方法在61例VMC和74例非病毒性心肌炎(NVMC)患儿及46例健康对照组中,用微粒子化学发光免疫分析法检测血清cTnI、MYO、CK-MB mass,并用连续监测法测定血清LDH、AST、CK和α-HBDH的活性。cTnI、MYO和CK-MB mass不同组合的诊断效率运用矩阵决策法评价。结果入院当日VMC组cTnI(0.46±0.21μg/L)、MYO(98.7±38.2μg/L)、CK-MB(6.1±4.2μg/L)均明显高于NVMC组(分别为0.06±0.04、39.2±26.8、2.2±1.7μg/L)和对照组(分别为0.07±0.04、36.5±24.7、2.1±1.5μg/L,P<0.01)。cTnI、MYO、CK-MB mass联合检测对VMC诊断的灵敏度、特异性、阳性预报值、阴性预报值和诊断准确度分别为90.16%、85.14%、83.33%、91.30%和87.41%,其特异性、阳性预报值和诊断准确度明显比四种心肌酶联合检测法高(P<0.05),而灵敏度和阴性预报值与后者相比差异无显著性(P>0.05)。MYO对VMC初诊的灵敏度较高,特异性欠佳,阳性持续时间短;cTnI与CK-MB对VMC诊断的特异性好,持续时间长,初诊时的灵敏度不够理想。VMC患者康复时以MYO恢复最快,CK-MB次之,cTnI最慢。结论联合动态检测cTnI、MYO和CK-MB mass可使VMC的诊断效率进一步提高。Objective To appraise the values of combined determination of cTnI, MYO and CK-MB mass in the diagnosis of viral myocarditis, Methods The myocardial injury markers （cTnI, MYO and CK-MB mass） and myocardial enzyme （LDH, AST, CK and α-HBDH） of 61 patients with viral myocarditis （VMC）, 74 patients with non-viral myocarditis （NVMC） and 46 healthy subjects were determined, respectively, by microparticle ehemilumineseent immunoassay and continuous monitoring assay. Diagnostic efficiency was calculated by matrix decision method. Results The serum levels of cTnI, MYO and CK-MB mass of the patients in VMC group were obviously higher than that of the patients in NVMC group （0. 46±0. 21 vs 0. 06±0. 04μg/L, 98. 7±38. 2 vs 39. 2±26. 8μg/L and 6. 1±4. 2 vs 2. 2 ±1. 7μg/L, respectively） as well as that of healthy subjects （0. 46±0. 21 vs0. 07±0. 04μg/L, 98. 7±38. 2 vs 36. 5±24. 7μg/L and 6. 1± 4. 2 vs 2. 1±1.5μg/L, respectively, P〈0. 01）. The diagnostic efficiency of combined determination of cTnI, MYO and CK-MB mass for VMC was 90. 16% in term of sensitivity （SE）, 85. 14% for specificity （SP）, 83. 33% for positive predictive value （＋PV）, 91. 30% for negative predictive value （-PV）, and 87. 41% for degree of accuracy （AC）, respectively. The SP, ＋PV and AC of three myocardial injury markers in combination were higher than that of the combination of four myocardial enzymes （ P〈0. 05）. As to the SE and -PV, however, no significant difference existed between the two methods （P〉0.05）. For preliminary diagnosis of VMC, the SE of MYO is highest, but the SP of cTnI and CK-MB mass were better choice. Restoration of MYO was earliest while cTnI was latest during convalescence of the patients.Conclusion Combined and uninterrupted determination of the myocardial injury markers can provide better diagnostic accuracy.

关 键 词：心肌炎 肌钙蛋白I 肌红蛋白 肌酸激酶 

分 类 号：R44[医药卫生—诊断学]