高敏肌钙蛋白T对不同风险分层非ST段抬高型心梗的诊断价值分析  

High-Sensitivity Troponin T for the Diagnosis of Non-ST Elevation Myocardial Infarction with Different Risk Stratification

作　　者：冯晓敏 刘玉薇 苏静静 赵雅 万楠[2] FENG Xiao-min;LIU Yu-wei;SU Jing-jing;ZHAO Ya;WAN Nan(Postgraduate Training Base of Shenyang Military Region General Hospital of Dalian Medical University ,Liaoning Dalian 116044 China;Department of Clinical Laboratory, the General Hospital of Shenyang Military, Shenyang 110016, China)

机构地区：[1]大连医科大学沈阳军区总医院研究生培养基地,辽宁大连116044 [2]沈阳军区总医院检验科,沈阳110016

出　　处：《现代检验医学杂志》2018年第3期141-143,147,共4页Journal of Modern Laboratory Medicine

基　　金：循环MicroRNA作为新型冠心病血浆标志物的相关研究(201602792)

摘　　要：目的探讨高敏肌钙蛋白T(hs-cTnT)对不同风险分层非ST段抬高型心肌梗死(NSTEMI)的诊断价值。方法选取2017年10~12月就诊于沈阳军区总医院急诊的胸痛患者381例(除外ST段抬高型心肌梗死和心律失常患者),根据全球急性冠状动脉事件注册(GRACE)危险评分将患者分为低、中和高危三组,采用电化学发光法检测患者血浆hs-cTnT水平,应用方差分析和受试者工作特征曲线(ROC曲线)判断hs-cTnT的诊断价值。结果低、中和高危组患者人数分别为239例、93例和49例;NSTEMI患病率分别为25.1%,41.9%和76.0%。低危组曲线下面积0.89(95%CI:0.84~0.93),特异度94%,敏感度59%,阴性预测值88%,阳性预测值73%。中危组曲线下面积0.92(95%CI:0.84~0.97),特异度83%,敏感度87%,阴性预测值90%,阳性预测值79%。高危组曲线下面积0.95(95%CI:0.85~0.99),特异度90%,敏感度90%,阴性预测值75%,阳性预测值97%。高危组血浆hs-cTnT浓度(0.96±1.5ng/L)明显高于中危组(0.41±0.75ng/L)和低危组(0.16±0.56ng/L),差异均有统计学意义(F=45.376,P<0.05)。3个组NSTEMI患者血浆hs-cTnT浓度均高于其他诊断患者,差异有统计学意义(P<0.05)。结论 hs-cTnT可以作为高风险NSTEMI早期诊断的指标,但对中、低危组诊断价值略低。Objective To investigate the value of high-sensitivity cardiac troponin T （hs-cTnT） to the diagnosis of non-ST el- evation myocardial infarction （NSTEMI） in patients with different risk stratification. Methods A total of 381 acute chest discomfort patients （excluding ST-elevation myocardial infarction and arrhythmia） who had been seen in Shenyang Military Region General Hospital emergency department from Oct, 2017 to Dec, 2017 were enrolled. According to the global GRACE risk score, the patients were divided into low,moderate and high risk groups. The plasma levels of hs-cTnT were detected by electrochemiluminescence method. Analysis of variance and receiver operating characteristic curve （ROC curve） were used to determine the diagnostic value of hs-cTnT. Results The number of patients in the low,moderate and high risk groups was 239,93 and 49,respectively. The prevalence of NSTEMI was 25.1% ,41.9% ,and 76.0% ,respectively. The area under the ROC curve in low risk group was 0.89 （95 % CI：0.84 ~0.93）, specificity was 94 %, sensitivity was 59 %, negative predictive value was 880./00 ,and positive predictive value was 73%. The area under the ROC curve in moderate risk group was 0.92 （95 % CI：0.84~0.97）, specificity was 83 %, sensitivity was 87 %, negative predictive value was 90 %, and positive predictive value was 79%. The area under the ROC curve in high risk group curve was 0.95 （95% CI：0. 85~0. 99）,specificity was 90%, sensitivity was 90% ,negative predictive value was 75 %, and positive predictive value was 97%. The level of plasma hs-cTnT was significantly higher in high-risk group than that in low-risk and middle-risk group （F= 45. 376, P〈0.05）. In all three groups, in patients with high-risk group, concentrations of hs-cTnT were significantly higher in patients with NSTEMI as compared with patients with other diagnoses （all P〈0.05）. Conclusion Hs-cTnT can be used as an indicator of early diagnosis of high-risk NSTEMI,but the diagnostic value of the low-risk group

关 键 词：高敏肌钙蛋白T GRACE危险评分 非ST段抬高型心肌梗死 

分 类 号：R541[医药卫生—心血管疾病] R446.112[医药卫生—内科学]