心肌肌钙蛋白诊断和除外急性心肌梗死界限值的探讨  

Value of cTn in diagnosis of acute myocardial infarction

作　　者：郝东亚[1] 朱宁[2] 

机构地区：[1]鄂尔多斯市中心医院心内科,内蒙古鄂尔多斯017000 [2]大连医科大学附属第二医院

出　　处：《临床心血管病杂志》2012年第2期119-123,共5页Journal of Clinical Cardiology

摘　　要：目的:探讨心肌肌钙蛋白(cTn)诊断和除外急性心肌梗死(AMI)的界限值。方法:因心血管疾病住院及尿毒症透析患者共334例,分为AMI组30例、心绞痛组90例、心力衰竭组56例、心律失常组41例、高血压组97例、尿毒症组20例。入院次日清晨空腹抽取血标本,同时测量cTnI、cTnT及肌酸激酶同工酶(CK-MB)。分析比较cTnI、cTnT及CK-MB达到正常参考人群数值的第95百分位数及2倍于此数值时对于诊断AMI的敏感性、特异性及准确性。结果:AMI组与其他各组相比,cTn和CK-MB增高差异有统计学意义(P<0.05);除AMI组外其他组患者cTnI、cTnT和CK-MB测定值均有部分高于正常参考人群数值的第95百分位数,且与AMI组有重叠。结论:cTnI和cTnT达到正常参考人群数值的第95百分位数时对AMI诊断的敏感性无明显差异,特异性cTnT高于cTnI。CK-MB的敏感性不高但是特异性很高,与cTnT类似,仍可做AMI排除诊断用。建议心肌标志物应该有2个界限值,一个是目前的正常参考人群数值的第95百分位数,为诊断AMI的界限值;另一个是2倍于此数值,用于排除非缺血性心肌损伤。Objective：To define a cut point of cTn and creatine kinase-myocardial band（CK-MB） in diagnosis of acute myocardial infarction（AMI）. Method：The concentrations of cTnI,cTnT,and CK-MB in the serum of the patients who were admitted to the Second Affiliated Hospital of Dalian Medical University during continuous three months were measured.Three hundred and thirty-four cases were collected.All patients were divided into 6 groups： 30 cases in AMI group,90 in angina pectoris group,56 in heart failure group,41 in cardiac arrhythmia group,97 in hypertensive group,and 20 in uremia group.Man-Whitney the U non-parametric test was processed and exper-iment fourfold table method was used to analyze the sensitivity,specificity and the accuracy of cTnI,cTnT and CK-MB respectively. Result：The serum cTn and CK-MB concentration in AMI patients were significantly higher compared with other groups（P0.05）,but the values of them in the other groups had overlapped with the AMI group. Conclusion：Both cTnI and cTnT had high sensitivity in diagnosing AMI,but the specificity of cTnT was higher than cTnI（99.6% vs 81.3%）.Therefore cTnT was recommended for AMI exclusion.The CK-MB in diagnosing AMI was not high in sensitivity but high in specificity,similarly as cTnT.The value of cTnT and CK-MB exceeding twice 95th percentile referent value could be accepted in AMI diagnosis.We suggest that cTn should have two critical values,one is for diagnosis of AMI and another for excluding non-ischemia damage of myocardium.

关 键 词：心肌梗死 急性 心肌肌钙蛋白 特异性 肌酸激酶同工酶 

分 类 号：R542.2[医药卫生—心血管疾病]