实验室检查对急性胸痛性质鉴别的意义  

Significance of Laboratory Examination in Identification of Characteristics of Acute Chest Pain

作　　者：辛天宇 刘树元[1] 单毅[1] 

机构地区：[1]海军总医院急诊科,北京100048

出　　处：《解放军医药杂志》2016年第5期87-90,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的探讨鉴别急性胸痛性质的综合诊断评价方法。方法海军总医院急诊科2014年4月—2015年4月救治急性胸痛患者127例,根据胸痛病因分为心源性胸痛组(69例)与非心源性胸痛组(58例)两组,比较两组一般资料及血常规、凝血常规、肝肾功能、动脉血气分析、心肌坏死标记物和N末端B型钠尿肽原(NT-pro BNP)水平的差异。结果与非心源性胸痛组比较,心源性胸痛组年龄更大、男性比例更高、心率更快、血压更低,差异均有统计学意义(P<0.01);心源性胸痛组肌酸激酶同工酶(CK-MB)、肌钙蛋白I(c Tn I)、肌红蛋白(Myo)、超敏C反应蛋白(hsCRP)、NT-pro BNP峰值均显著高于非心源性胸痛组(P<0.01)。结论在问诊、查体及医技检查的基础上联合检测CK-MB、c Tn I、Myo、hs-CRP、NT-pro BNP等指标对急性胸痛性质的早期、快速鉴别具有重要临床价值。Objective To discuss the comprehensive methods of diagnosis and evaluation for identifying characteristics of acute chest pain.Methods A total of 127 patients with acute chest pain admitted during April 2014 and April2015 were divided into cardiogenic chest pain group（ n = 69） and non-cardiogenic chest pain group（ n = 58） according to the causes of chest pain.Clinical data and values of routine blood examination,blood clotting,liver and kidney functions,arterial blood gas analysis,myocardial necrosis markers and N-terminal B-type natriuretic peptide（ NT-pro BNP） levels were compared in the two groups.Results Compared with those in non-cardiogenic chest pain group,patients in cardiogenic chest pain group had an older age,a higher proportion of male patients,a faster heart rate and a lower level of blood pressure,and the differences were statistically significant（ P〈0.01）;peak values of MB isoenzyme of creatine kinase（ CK-MB）,troponin I（ c Tn I）,myoglobin（ Myo）,high-sensitivity C-reactive protein（ hs-CRP） and N-terminal brain natriuretic peptide（ NT-pro BNP） were significantly higher in cardiogenic chest pain group（ P〈0.01）.Conclusion Combined detection of indexes such as CK-MB,c Tn I,Myo,hs-CRP and NT-pro BNP on the basis of interrogation,physical examination and medical examination have clinical value in early and quick identification of acute chest pain.

关 键 词：胸痛 急症 肌酸激酶同工酶 肌钙蛋白I 肌红蛋白 超敏C反应蛋白 N末端B型钠尿肽原 

分 类 号：R441.1[医药卫生—诊断学] R446.1[医药卫生—临床医学]