常见心肌损伤标志物在急性心肌梗死诊断中的应用价值  

Evaluation of common myocardial injury markers in the diagnosis of acute myocardial infarction

作　　者：钱净[1] 李雪[2] 杨丽琼[1] 施茜[1] QIAN Jing;LI Xue;YANG Liqiong;SHI Qian(Department of Clinical Laboratory,the First People′s Hospital ofKunming,Kunming,Yunnan 650011,China;2015 Graduate Student, Kunming Medical University,Kunming,Yunnan 650011,China)

机构地区：[1]云南省昆明市第一人民医院检验科,650011 [2]昆明医科大学,2015级研究生昆明650031

出　　处：《检验医学与临床》2019年第1期31-34,共4页Laboratory Medicine and Clinic

基　　金：云南省昆明市科技计划资助项目(2016-1-S-06793)

摘　　要：目的评价4种常见心肌损伤标志物——心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、心脏型脂肪酸结合蛋白(H-FABP)在急性心肌梗死(AMI)中的临床诊疗价值。方法收集2017年1―12月该院以"急性胸痛"症状为主诉收住入院的200例患者,应用受试者工作特征(ROC)曲线评价各心肌损伤标志物单独及联合检测在AMI中的临床诊断性能。结果 (1)AMI组cTnT、CK-MB、MYO、HFABP分别为0.162(0.027～0.457)μg/L、14.660(8.570～17.630)μg/L、149.000(68.000～234.000)μg/L、(6.330±1.990)ng/L,与非AMI组[0.007(0.005～0.010)μg/L、1.650(1.220～3.080)μg/L、34.000(25.000～75.000)μg/L、(4.000±1.560)ng/L]比较,差异有统计学意义(P<0.05)。(2)AMI组各指标单独检测阳性率高于非AMI组(P<0.05),联合检测的阳性率高于单项指标检测(P<0.05)。(3)cTnT、CK-MB、MYO、H-FABP的最佳诊断界值(Cut Off)分别为0.014 5μg/L、7.780 0μg/L、110.000 0μg/L、5.900 0ng/L。(4)cTnT、CK-MB、MYO、H-FABP单项及联合检测的临床诊断性能中,准确度最高的项目是cTnT(91.5%),灵敏度最高的项目是cTnT(89.3%),特异度最高的项目是cTnT(92.0%),阳性拟然比最高的项目是cTnT(11.2),阴性拟然比最低的项目是cTnT(0.12)。4项指标联合检测的诊断性能优于3项指标联合检测(P<0.05),并均高于各指标单项检测(P<0.05)。结论心肌损伤标志物在AMI诊断中具有重要的临床应用价值,各临床实验室应根据各自的检测条件确立适当的临床诊断界值。cTnT、CK-MB、MYO、H-FABP联合检测诊断性能均高于各单项指标,但单项指标各具优势,应根据临床对AMI的诊疗需求选择合适的联合或单项指标检测。Objective To evaluate four common myocardial injury markers:cardiac troponin T(cTnT),creatine kinase MB isoenzyme(CK-MB),myoglobin(MYO),and heart-type fatty acid-binding protein(H-FABP)to the clinical diagnosis and treatment value of acute myocardial infarction(AMI).Methods A total of 200 patients(120 males and 80 females)who were admitted to hospital with main symptoms of"acute chest pain"were collected from January to December in 2017 in our hospital.ROC curves were used to evaluate the markers of myocardial injury alone and in combination of clinical diagnostic performance in AMI.Results(1)The levels of cTnT,CK-MB,MYO,and H-FABP in the AMI group were 0.162(0.027―0.457)μg/L,14.66(8.57―17.63)μg/L,149(68―234)μg/L,(6.33±1.99)ng/L,respectively.The levels of cTnT,CK-MB,MYO and H-FABP in non-AMI groups and were 0.007(0.005―0.010)μg/L and 1.65(1.22―3.08)μg/L,34(25―75)μg/L,(4.00±1.56)ng/L,respectively.The levels of cTnT,CK-MB,MYO and H-FABP were significantly different(P<0.05).(2)The positive rate of each indicator in the AMI group was higher than that in the non-AMI group(P<0.05).The positive rate of the combined test was higher than that of the single indicator.(3)Cut Off of cTnT,CK-MB,MYO and H-FABP were 0.014 5μg/L,7.780 0μg/L,110.000 0μg/L and 5.900 0 ng/L,respectively.(4)Among the clinical diagnostic performances of cTnT,CK-MB,MYO,H-FABP single and combined detection,the highest accuracy item was cTnT with 91.5%and the highest sensitivity was cTnT with 89.3%and the highest specificity was cTnT with 92.0%.The highest positive likelihood ratio items was cTnT,with 11.2,and the lowest negative likelihood ratio item was cTnT with 0.12.The four combined tests had the highest diagnostic performance than the three combined tests and each item.Conclusion Myocardial injury markers have important clinical application value in the diagnosis of AMI.Each clinical laboratory should establish the appropriate clinical diagnostic threshold according to their respective test conditions;cTnT,CK-MB,MYO,H-FABP c

关 键 词：心肌损伤标志物 急性心肌梗死 受试者工作特征曲线 

分 类 号：R446.1[医药卫生—诊断学]