前白蛋白对急性心肌梗死的早期预警价值  

The value of prealbumin in the early diagnosis of acute myocardical infarction

作　　者：祖素云 杨贵荣[2] 马增春[3] 高敏[2] 赵海滨[2] 王丹[2] 杨长春[2] 

机构地区：[1]抚宁县人民医院内三科,河北抚宁066300 [2]武警总医院,北京100039 [3]军事医学科学院放射医学研究所,北京100850

出　　处：《东南国防医药》2016年第1期13-16,共4页Military Medical Journal of Southeast China

基　　金：国家自然科学基金资助项目(81274127)

摘　　要：目的探讨前白蛋白对12 h内就诊的缺血性胸痛患者急性心肌梗死（acute myocardial infarction,AMI）的早期预警价值。方法选取以胸痛为主诉的12 h内发病的疑诊急性心肌梗死180例为研究对象,其中确诊AMI 103例。根据发病时间不同,将AMI患者分为0~3 h、4~6 h和7~12 h组,检测其前白蛋白、高敏肌钙蛋白T（hs-c Tn T）、肌酸激酶同工酶（CKMB）水平,比较前白蛋白及肌钙蛋白T、肌酸激酶同工酶诊断AMI的敏感性、特异性、阳性预测值、阴性预测值。结果发病0~3 h,前白蛋白诊断AMI的敏感性为23.70%[95%可信区间（CI）：17.00%~31.94%]、特异性73.33%（95%CI：57.79%~84.90%）、阳性预测值0.89、阴性预测值1.04;随发病时间延长,前白蛋白诊断AMI的敏感性增加,发病7~12 h PA诊断敏感性、特异性分别为53.33%（95%CI：44.58%~61.90%）、57.78%（95%CI：42.24%~72.01%）,同期hs-c Tn T及CK-MB诊断AMI的敏感性、特异性分别为95.56%（95%CI：90.16%~98.18%）、80%（95%CI：64.95%~89.91%）、78.52%（95%CI：70.45%~84.92%）、73.33%（95%CI：57.79%~84.90%）,与hs-c Tn T及CK-MB相比,发病7~12 h前白蛋白诊断AMI的准确性低于hsc Tn T及CK-MB。结论前白蛋白在早期对急性心肌梗死具有一定预警价值,但诊断急性心肌梗死敏感性、特异性较低。Objective To investigate the accuracy of prealbumin in warning acute myocardial infarction（ AMI） in patients with chest pain of presumed ischemic origin in 12 hours admitted to hospital. Methods 180 patients with ischemic chest pain who suspected to acute myocardial infarction admitted to emergency department of the general hospital of Chinese people＇s armed police forces in 12 hours from April 2013 to April 2014 were enrolled in this study. According to the onset time,103 patients diagnosed AMI were divided into group 0-3 h,group 4-6 h and group 7-12 h. Serum prealbumin,high sensitive troponin T（ hs-c Tn T） and creatine kinase myocardial band（ CK-MB） at admission were detected. At the same time,sensitivity,specificity,positive predictive value and negative predictive value of prealbumin,hs-c Tn T and CK-MB for acute myocardial infarction were compared respectively. Results 0- 3 h at onset,prealbumin testing to identify myocardial infarction in patients with chest pain of presumed ischemic origin had a sensitivity of23. 70% [95% confidence interval（ CI） 17.00%-31.94%]and a specificity of 73.33%（ 95%CI 57.79%-84.90%）,a positive predictive value of 0.89 and a negative predictive value of 1.04. With the development of disease,prealbumin dignostic sensitivity increased,while specificity had no change. 7-12 h after admission,prealbumin had a sensitivity of 53.33%（ 44.58%-61.90%） and a specificity of 57.78%（ 42.24%-72.01%）. The sensitivity and specificity of corresponding hs-c Tn T and CK-MB was 95.56%（ 90.16%-98.18%）,80%（ 64.95%-89.91%）,78.52%（ 70.45%-84.92%）,73.33%（ 57.79%- 84.90%） respectively,thus diagnostic accuracy of prealbumin at 7-12 h was lower than that of hs-c Tn T and CK-MB. Conclusion Prealbumin is a certain value to AMI diagnosis at early stage,but specificity and sensitivity is lower.

关 键 词：急性心肌梗死 前白蛋白 预警 诊断 

分 类 号：R542.22[医药卫生—心血管疾病]