高敏感心肌肌钙蛋白T检测方法在诊断急性心肌梗死中的价值  

Clinical application of high-sensitivity cardiac troponin T assay in the diagnosis of acute myocardial infarction

作　　者：吴炯[1] 宋凌燕[1] 张春燕 郭玮[1] 宋斌斌[1] 王蓓丽[1] 唐斌[2] 西雁[2] 潘柏申[1] 

机构地区：[1]复旦大学附属中山医院检验科,上海200032 [2]复旦大学附属中山医院心内科,上海200032

出　　处：《中华检验医学杂志》2010年第9期825-830,共6页Chinese Journal of Laboratory Medicine

基　　金：基金项目：上海市科委科研计划项目（08411960400）

摘　　要：目的 评价hs-cTnT在AMI诊断中的临床应用价值.方法 比较147例确诊AMI患者（其中122例为NSTEMI患者）入院即刻样本hs-cTnT、con-cTnT检出阳性率.检测481例胸痛患者入院5个不同时间点（入院即刻和入院后4、12、20和28 h）血清样本的hs-cTnT、con-cTnT、CKMB mass和MYO浓度,比较确诊AMI患者各指标不同时间点的检出阳性率.依据ROC曲线分析比较各心脏标志物对AMI的诊断特性.动态监测比较AMI组、非AMI心脏疾病组、AMI相关高危疾病组和表面健康对照组入院4 h内hs-cTnT浓度变化率.结果 确诊AMI和NSTEMI患者人院即刻hs-cTnT的检出阳性率分别为90.3%和91.0%,明显高于con-cTnT的61.9%和60.6%（x2值分别为23.08、18.64,P均＜0.01）.人院各时间点不同指标（hs-cTnT、con-cTnT、CKMB mass和MYO）检测中,hs-cTnT检出阳性率最高为100%（入院4 h后）,con-cTnT最高为99.2%（入院12 h后）,CKMB mass最高为92.1%（入院12 h后）,MYO最高为74%（人院4 h后）.hs-cTnT、con-cTnT、CKMB mass和MYO入院即刻的ROC曲线下面积（AUC）分别为0.935、0.851、0.827和0.769,hs-cTnT与con-cTnT、CKMB mass和MYO之间AUC差异均有统计学意义（Z1=3.13,Z2=4.46,Z3=5.62,P均＜0.05）.动态监测AMI组变化率与其他3组变化率分别为203.03%（25.00%～2036.40%）、0.00%（-3.48%～5.21%）、0.00%（-1.17%～2.00%）、-1.97%（-3.83%～0.007%）,差异有统计学意义（x2=166.09,P＜0.01）.结论 相比con-cTnT,hs-cTnT检测能够为AMI的更早期诊断提供可靠依据,减少NSTEMI患者的误诊或漏诊.单点hs-cTnT判断值结合动态监测变化明显优于仅仅使用单点判断值,hs-cTnT判断值结合动态监测变化的诊断特性明显优于单独使用判断值,有助于鉴别诊断因hs-cTnT检测灵敏度提高而增多的疑似AMI患者.由于具有良好的诊断特性,hs-cTnT检测可能使一些＂早期标志物＂的应用空间大大缩小.Objective To evaluate the clinical application of hs-cTnT in diagnosis of AMI. Methods The detectable rates of hs-cTnT and con-cTnT from 147 AMI （ including 122 NSTEMI ）patients on immediate admission were compared. The related biological markers including hs-cTnT, con-cTnT, CKMB mass and MYO were determined for all samples from 481 patients with chest pain on immediate admission and 4 h, 12 h ,20 h and 28 h after admission. The receiver operating characteristic curve was used to evaluate the sensitivity and specificity of all markers. The change rates of hs-cTnT within 4 hours from AMI group, non-AMI heart disease group, AMI related high risk disease group and control group were compared with serial detection. Results The detection rates of hs-cTnT for AMI and NSTEMI patients were 90. 3% and 91.0%, and both were significantly higher than the rates of con-cTnT, which were 61.9% and 60. 6% （x2 =23.08,18. 64,all P〈0. 01 ）. Among different makers obtained from different collecting times,hs-cTnT had the highest detection rate. For admission cases, the area under curve of hs-cTnT, con-cTnT,CKMB mass and MYO were 0.935, 0.851, 0.827 and 0.769 respectively, and the differences have statistical significance（Z1 = 3. 13, Z2 = 4. 46, Z3 = 5.62, all P 〈 0. 05 ）. Besides, there was a significant difference between the change rate of hs-cTnT of AMI and other groups （x2=166.09,P〈0. 01）.Conclusions In comparison with con-cTnT, hs-cTnT could provide reliable results for earlier diagnosis of AMI, and could also reduce misdiagnosis and missed diagnosis of NSTEMI. Combining single test of hs-cTnT with serial tests was superior to using cut-off value alone in diagnosis. Moreover, it could be helpful to distinguish non-AMI patients from true AMI patients due to the improved detection sensitivity. Because of its good diagnostic performance, hs-cTnT test may limit the application value of some other ＂early markers＂.

关 键 词：肌钙蛋白T 心肌梗死 诊断技术和方法 评价研究 

分 类 号：R542.22[医药卫生—心血管疾病]