高敏心肌肌钙蛋白T检测在急性心肌梗死诊断中临床应用  

Clinical Application of High-sensitivity Cardiac Troponin T in the Diagnosis of Acute Myocardial Infarction

作　　者：王家安[1] 田玉峰[1] 律洁[1] 秦燕[1] 董彦军[1] 

机构地区：[1]山东省日照市人民医院,山东日照276826

出　　处：《标记免疫分析与临床》2015年第3期177-180,共4页Labeled Immunoassays and Clinical Medicine

基　　金：国家高科技研究发展计划(863计划)(2011AA02A111)

摘　　要：目的探讨高敏肌钙蛋白T(hs-c Tn T)在急性心肌梗死(AMI)诊断中的临床应用价值。方法采用电化学发光免疫法对240例AMI患者血清hs-c Tn T及常规c Tn I水平进行检测,同时绘制受试者工作特征曲线(ROC),根据曲线建立临床适用的hs-c Tn T诊断界值,并比较hs-c Tn T及常规c Tn I对AMI诊断的准确性。结果 AMI组患者血清hs-c Tn T水平均高于0.014ng/m L(健康人群99百分位值),其中ST抬高型心肌梗死(STEMI)患者组水平高于非ST抬高型心肌梗死(NSTEMI)患者组(χ2=68.573,P<0.05);hs-c Tn T的ROC曲线下面积(AUC)为0.905,显著高于传统c Tn I的0.793(Z=2.896,P<0.05),hs-c Tn T联合CK-MB可使AUC从0.905增加至0.954(Z=2.098,P<0.05),以0.014ng/m L作为cutoff值时,其对AMI诊断敏感度可达100%,但特异度仅为45.5%,以Youden指数最高(0.654)对应的0.035ng/m L作为cut-off值时,对AMI的诊断综合能力最强,敏感度为91.8%,特异度为74.9%。结论 hs-c Tn T对AMI的诊断价值要优于传统c Tn I检测,但其在提高诊断灵敏度的同时,也会使很多非AMI疾病患者hs-c Tn T水平超过诊断界值,应注意鉴别诊断;以ROC曲线Youden指数最高对应的hs-c Tn T数值作为AMI的诊断界值,在临床实践中更为适用。hs-c Tn T检测与临床应用方面仍有许多问题有待解决,还需要进一步临床研究证实。Objective To investigate the clinical value of high-sensitivity troponin T（ hs-c Tn T） in the diagnosis of patients with acute myocardial infarction（ AMI）. Methods Serum hs-c Tn T and routine c Tn I concentrations from 240 AMI patients were measured by electrochemiluminescence immunoassay,and the receiver operating characteristic curve（ ROC） was drawn. Based on the above curve,the cutoff value of hs-c Tn T applying in clinical diagnosis was established and the accuracy of diagnosing AMI was compared between hs-c Tn T and c Tn I. Results The serum Hs-c Tn T levels in AMI patients were more than 0. 014 ng / m L（ 99 th percentile value in healthy people）,and the Hs-c Tn T levels in ST elevation myocardial infarction（ STEMI） patients were higher than that of non-ST-elevation myocardial infarction（ NSTEMI） patients（ χ2= 68. 573,P〈0. 05）. The area under the ROC curve for hs-c Tn T（ AUC） was 0. 905,which was significantly higher than the traditional c Tn I of0. 793（ Z = 2. 896,P〈0. 05）. The combination of hs-c Tn T and CK-MB resulted was increase with AUC from0. 905 to 0. 954（ Z = 2. 098,P〈0. 05）. Taking 0. 014 ng / m L as cut-off value,the diagnostic sensitivity of AMI could be 100%,but the specificity was only 45. 5%. When taking 0. 035 ng / m L as cut-off value which was the highest Youden index,the ability of diagnosing AMI comprehensively was the strongest,the diagnostic sensitivity and specificity could be 91. 8% and 74. 9%,respectively. Conclusion The diagnostic value of hs-c Tn T for AMI was superior to conventional c Tn I assay,but the improvement of the sensitivity also led to the hs-c Tn T levels of non-AMI patients surpassing the cutoff value simultaneously,which should be paid attention for the differential diagnosis. While cutoff value of AMI corresponded to the highest Youden index in ROC curve,it was more applicable in clinical practice. There were still many issues about the detection and clinical applications of hs-c Tn T,which need further clinical studie

关 键 词：高敏心肌肌钙蛋白T 急性心肌梗死 受试者工作特征曲线 诊断价值 

分 类 号：R542.22[医药卫生—心血管疾病]