血浆心肌细胞损伤标志物检测急性心肌梗死患者心肌损伤的临床研究  

The clinical study of plasma myocardial cell damage markers in detecting myocardial injury patients with acute myocardial infraction

作　　者：赵若愚[1] 鲍逸民[1] 杨永青[2] 

机构地区：[1]南京医科大学附属苏州市立医院本部急诊科,苏州215002 [2]南京医科大学附属苏州市立医院本部核医学科,苏州215002

出　　处：《国际放射医学核医学杂志》2014年第4期235-238,共4页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的 探讨血浆心肌细胞损伤标志物在检测急性心肌梗死（AMI）患者心肌损伤中的价值.方法 采用放射免疫分析法测定184例AMI患者和60名健康体检者（正常对照组）血浆心肌肌钙蛋白Ⅰ（CTnⅠ）、TNF-α、高敏C反应蛋白（hs-CRP）和β2微球蛋白（β2-MG）水平,并进行比较性分析.同时测定它们诊断AMI的特异度、阳性、阴性预测值、准确率以及入院后3、6、9h时的灵敏度.结果 184例AMI患者血浆CTnⅠ、TNF-α、hs-CRP和β2-MG水平较正常对照组均显著升高（tCTnⅠ=6.384,P＜0.001;tTNF-α=2.136,P＜0.05;ths-CRP=5.109,P＜0.001;tβ2-MG =3.185,P＜0.01）,以血浆CTnⅠ和hs-CRP水平升高最为显著.血浆CTnⅠ、TNF-α、hs-CRP和β2-MG水平对AMI患者诊断的特异度分别为96.67％、51.67％、65.00％和48.33％.入院后3、6和9h时对AMI患者诊断的灵敏度：血浆CTnⅠ分别为21.74％、92.93％和98.37％;血浆TNF-α分别为17.93％、65.76％和69.02％;血浆hs-CRP分别为16.30％、78.26％和79.89％;血浆β2-MG分别为21.20％、69.57％和74.46％;以血浆CTnⅠ为最高.阳性、阴性预测值和有效率亦以血浆CTnⅠ为最高,分别为89.67％、88.33％、89.24％.结论 心肌细胞损伤标志物CTnⅠ不仅是早期诊断AMI的有效指标,而且具有治疗随访的临床价值.Objective To explore the value of plasma myocardial cell damage markers in detecting myocardial injury patients with acute myocardial infraction（AMI）.Methods The plasma cardiac troponin Ⅰ （CTnⅠ）,TNF-α,high sensitive C-reaction protein （hs-C RP） and β2-microglobulin （β2-MG） levels in 184 patients with AMI and 60 controls were determined by radioimmunoassay,and then the comparative analysis were carried on.The positive and negative predictive value,the specificity,the effective rate and the sensitivity of these myocardial cell damage markers at 3 h,6 h,9 h after admission to the hospital were determined.Results The plasma CTnⅠ,TNF-α,hs-CRP and β2-MG levels in 184 patients with AMI were significantly higher than those in 60 controls （tcrnⅠ=6.384,P〈0.001; tTNF-α=2.136,P〈0.05; ths-CRP=5.109,P〈0.001; tβ2-MG =3.185,P〈0.01）.The plasma CTnⅠ and hs-CRP levels increased significantly.The specificity of plasma CTnⅠ,TNF-α,hs-CRP and β2-MG were 96.67%,51.67%,65.00% and 48.33% respectively in the diagnosis of AMI patients.The sensitivity of these myocardial cell damage markers in the diagnosis of AMI patients at 3 h,6 h and 9 h after admission were showed as follows：the plasma CTnⅠ were 21.74%,92.93% and 98.37% respectively; the plasma TNF-αt were 17.93%,65.76% and 69.02% respectively; the plasma hs-CRP were 16.30%,78.26% and 79.89% respectively,and the plasma β2-MG were 21.20%,69.57% and 74.46% respectively,and the sensitivity of plasma CTnⅠ was the highest.The positive,negative predict value and effective rate of plasma CTnⅠ were the highest also,and they were 89.67%,88.33%,89.24% respectively.Conclusion The plasma CTnⅠ levels of myocardial cell damage markers was a valuable index in the early diagnosis of AMI,and had clinical value in treatment following.

关 键 词：心肌梗死 肌钙蛋白Ⅰ 肿瘤坏死因子α Β2微球蛋白 C反应蛋白质 放射免疫测定 TROPONIN Ⅰ Tumor NECROSIS factor-α 

分 类 号：R542.22[医药卫生—心血管疾病]