高敏感性肌钙蛋白T和N端B型利钠肽原在非ST段抬高型急性冠状动脉综合征早期诊断中的应用  

Evaluation on High-Sensitivity Troponin-T and N-Terminal Pro-B Type Natriuretic Peptide in the Early Diagnosis of Non-ST-Elevation Myocardial Infarction

作　　者：张红梅[1] 余洁[1] 詹燏[1] 孔曼[1] 卢忠心[1] 

机构地区：[1]武汉市中心医院检验科,湖北武汉430014

出　　处：《武汉大学学报（医学版）》2014年第4期550-555,共6页Medical Journal of Wuhan University

摘　　要：目的:探讨传统和高敏感性肌钙蛋白T(hs-cTnT)及N端B型利钠肽原(NT-proBNP)单独及联合应用对非ST段抬高型急性冠状动脉综合征(NSTE-ACS)的早期诊断价值。方法:比较176例NSTE-ACS患者和240例非缺血性胸痛(NICP)患者血清hs-cTnT、cTnT和NT-proBNP水平,依据ROC曲线分析各指标单独和联合对NSTE-ACS的诊断特性,并将64排CT心脏影像检测异常结果与血清学指标比较分析。结果:NSTE-ACS患者血清hs-cTnT、cTnT、NT-proBNP水平均高于健康对照组和非缺血性胸痛组(P<0.05);NSTE-ACS患者血清hscTnT和NT-proBNP水平在胸痛3h内及3-6h均高于健康对照组(P<0.05),而cTnT水平在胸痛3-6h高于健康对照组(P<0.05)。Hs-cTnT(或cTnT)与NT-proBNP联合检测双阴性结果对NSTE-ACS诊断的敏感性由71.2%(45.4%)提高到90.5%(86.3%)(P<0.05),阴性预测值都接近99%。Hs-cTnT+NT-proBNP联合检测对NSTE-ACS诊断的ROC曲线下面积(AUC)从0.81提高到0.91(P<0.05)。Hs-cTnT或cTnT阳性患者CT影像检查异常百分率高于hs-cTnT(或cTnT)与NT-proBNP双阴性患者,也高于NT-proBNP单阳性患者,而双阴性患者CT影像异常百分率最低(P<0.01)。结论:Hs-cTnT(或cTnT)联合NT-proBNP检查提高了对临床症状不典型的低中危NSTE-ACS患者早期诊断的敏感性,结果得到CT心脏影像结果证实。Objective： To evaluate the dual-marker strategy of combined assaying conventional or high- sensitivity troponin-T （cTnT or hs-cTnT） with N-terminal pro-B type natriuretic peptide （NT- proBNP） in the early diagnosis of non-ST-elevation acute coronary syndrome （NSTE-ACS） with a single blood draw. Methods： In 176 patients with nonischemic electrocardiogram who underwent 64-slice cardiac computed tomography （CT） and 240 non-ischemic chest pain patients, we measured cTnT, hs-cTnT, and NT-proBNP. Sensitivity, specificity, and AUC were also calculated through ROC. Results： Patients with NSTEMI had higher concentrations of each biomarker compared with those without （all P〈0.05）. The levels of hs-cTnT and NT-proBNP in NSTE- ACS group within 3 hours and between 3 to 6 hours were higher than that of the control group, but only the level of cTnT within 3 to 6 hours were higher in the NSTE-ACS than those of thecontrol group. Dual-negative marker results improved sensitivity （cTnT：from 45.4% to 86.3%, hs-cTnT.from 71.2% to 90.5%; all P〈0.05）. Combining NT-proBNP with cTnT or hsTnT improved the AUC from 0.68 to 0.79 （P〈0.05） or from 0.78 to 0.86 （P〈0.05）, respectively. Patients with dual-negative markers had the lowest percentage of abnormal cardiac CT features, but hs-cTnT or cTnT positive had the highest percentage （all P〈0.05）. Conclusion： For patients with low-intermediate likelihood of NSTE-ACS, combined assaying natriuretic peptides with either conventional or highly-sensitive troponin improved the sensitivity of early diagnosis, and these findings were supported by structural and functional CT results.

关 键 词：非ST段抬高型急性冠状动脉综合征 高敏感性肌钙蛋白T N端B型利钠肽原 

分 类 号：R446.11[医药卫生—诊断学]