高敏心肌肌钙蛋白T在急性心肌梗死早期诊断中的临床价值  

Clinical value of high sensitivity cardiac troponin T in the diagnosis of acute myocardial infarction

作　　者：杨硕[1] 怀伟[2] 刘桂花[2] 吴健[1] 张捷[1] 

机构地区：[1]北京大学第三医院检验科,100194 [2]北京大学第三医院急诊科,100194

出　　处：《中华检验医学杂志》2014年第2期150-154,共5页Chinese Journal of Laboratory Medicine

基　　金：首都特色基金资助项目;国家科技支撑计划课题资助项目（2012BA137801）

摘　　要：目的建立临床适用的高敏心肌肌钙蛋白T（hs．cTnT）诊断急性心肌梗死（AMI）的临界值和最佳联合检测方案，以期最大限度的体现其在AMI早期诊断中的临床价值。方法前瞻性研究。选取2012年6月至2013年6月就诊于北京大学第三医院急诊科的胸痛、胸闷、心前区不适患者342例以及慢性肾脏病患者43例、肺炎患者40例、早产儿动脉导管未闭（PDA）患者18例。检测胸痛患者就诊即刻血浆hs-cTnT、N末端脑钠肽前体（NT—proBNP）、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶MB（CK—MB）以及和肽素浓度。分析不同疾病组hs—cTnT水平，绘制受试者工作特征曲线（ROC）评估比较hs—cTnT和cTnl对于早期诊断AMI的价值和联合检测hs—cTnT、CK-MB、NT—proBNP、和肽素对于提高AMI早期诊断准确性的作用。统计学方法计算hs—cTnT诊断AMI的敏感度、特异度、阴性预测值和阳性预测值等指标。结果sT抬高型心肌梗死（STEMI）组hs-cTnT水平最高（中位数为0．52μg/L，范围为0．037～7．610μg/L），其次为非ST抬高型心肌梗死（NSTEMI）组（中位数为0．1275μg/L，范围为0．021—4．260μg/L），但其他疾病组hs—cTnT亦出现不同程度的增高（Chi—square=76．432，P〈0．05）。hs—cTnT诊断AMI性的ROC曲线下面积（AUC）为0．862（95％CI：0．900—0．989），床旁检测（POCT）cTnI的AUC为0．748（95％CI：0．666—0．818）（Z：2．713，P〈0．05）。以0．014μg/L作为诊断界值（cut—off）诊断AMI的敏感度高达100％，但特异度仅为44．4％。以0．035μg/L作为cut-off值的Youden指数最高，敏感度为95．1％，特异度为65．7％。联合hs—cTnT、NT—proBNP和CK—MB使AUC提高至0．915（95％CI：0．838—0．964）（Z=2．147，P〈0．05），hs—cTnT与和肽素联合检测使AUC提高至0．921（95％CI：0．820～0．975）（Z=2．589，P〈0．05）。结论以0．035μg/L作为AMI的诊断Objective To establish an appropriate cut-off value of high sensitivity cardiac troponin T （hs-cTnT） and optimal combination measurement in the early diagnosis of acute myocardial infarction （AMI）. Methods This research is a prospective study. 342 patients admitted to emergency department with chest pain,43 patients with renal failure, 40 patients with pneumonia and 18 premature with patent duetus arteriosus were involved from June 2012 to June 2013 in Peking University Third Hospital. The plasma hs-TnT, NT-proBNP, cardiac troponin I （eTnI）, CK-MB and copeptin were measured. The distribution of hs-cTnT among associated diseases was analyzed, the diagnostic performance of hs-cTnT and the role of combination hs-eTnT with NT-proBNP, CK-MB and copeptin were evaluated by receiver operating characteristic （ROC） curve. The statistical method was used to calculate the Sensitivity, specificity, negative predictive value and positive predictive value of hs-cTnT in the diagnosis of AMI. Results As compared to patients with STEMI（median 0. 52 μg/L, range 0. 037 -7. 610 μg/L）, hs-cTnT was lower in the patients with Non-STEMI（ median 0, 127 5 μg/L, range 0. 021 -4. 260 μg/L）. However, the levels of hs-TnT in other diseases were also increased increased in varying degrees （ Chi-square = 76. 432, P 〈 0. 05） ] The areas under the curve （AUC） for hs-cTnT and cTnI in the diagnosis of AMI were 0. 862 （95% CI： 0. 729 - 0. 928 ） and 0. 748 （95 % CI 0. 666 - 0. 818 ） respectively （ Z = 2.713, P 〈 0. 05 ）. Taking 0.014μg/L and 0. 035 μg/L as cut-off value of hs-TNT, the sensitivities were 100% vs 95.1% ,the specificities were 44. 4% vs 65.7% . The combination of hs-cTnT, NT-proBNP, CK-MB resulted in a increase in AUC （0. 915,95% CI： 0. 838 - 0. 964） （ Z = 2. 147, P 〈 0.05 ） and the combination of hs-cTnT and copeptin resuIted in a increase in AUC 0. 921 （95% CI：0. 820-0. 975） （Z = 2. 589,P 〈 0. 05）. Conclusion With the cut：off value of 0. 035μg/L for diag

关 键 词：急性冠状动脉综合征 心肌梗死 肌钙蛋白T 敏感性与特异性 

分 类 号：R542.22[医药卫生—心血管疾病]