院外急救中即时检测CK-MB、cTnI和Myo对心肌梗死的早期预测价值临床研究  

Predictive value of point-of-care testing of CK-MB,cTnI,and Myo for acute myocardial infarction in emergency treatment

作　　者：张义龙 李保军[1] 靳波 黄来[1] 潘晶[1] 刘淼 张义淼 李飞妮[1] 方芳[1] 陈韦[2] ZHANG Yilong;LI Baojun;JIN Bo;HUANG Lai;PAN Jing;LIU Miao;ZHANG Yimiao;LI Feini;FANG Fang;CHEN Wei(Huanggu Second Center,Shenyang Emergency Center,Shenyang Liaoning 110000,China)

机构地区：[1]沈阳急救中心,辽宁沈阳110000 [2]辽宁中医药大学附属医院,辽宁沈阳110000

出　　处：《中国急救复苏与灾害医学杂志》2022年第9期1155-1159,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2020年沈阳市卫生健康委科研课题计划项目(编号:2020096)。

摘　　要：目的评估肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)和肌红蛋白(Myo)对早期诊断急性心肌梗死(AMI)的分析性能。方法研究2019年8月—2020年11月沈阳急救中心接诊疑似AMI急性发作患者共487例。急救医生到现场后,收集患者病历资料、监测心电图及用即时检测(POCT)检测CK-MB、cTnI和Myo。按最终诊断将患者分为AMI组和非AMI组,比较AMI患者和非AMI患者的临床特征以及AMI患者中心肌损伤标志物异常者和心肌损伤标志物正常者的临床特征;以试剂盒给出的参考值为诊断界值时的敏感度、特异度、阴性预测值(NPV)和阳性预测值(PPV)。结果487例胸痛患者中,有169例(34.7%)最终确诊为AMI。AMI患者和非AMI患者的男性所占比例(76.33%vs.60.38%)和心电图异常[Q波异常(67.46%vs.0.31%),ST段异常(67.46%vs.0)]者所占的比例差异均有统计学意义(P<0.05)。AMI患者中,心肌损伤标志物异常者80例。与心肌损伤标志物异常组比较,心肌损伤标志物正常组年龄更轻[(59.44±11.86)岁vs.(64.94±14.45)岁],心电图异常者比例更高[Q波异常(67.46%vs.0.31%),ST段异常(67.46%vs.0)],差异均有统计学意义(P<0.05)。以试剂盒给出的参考值为诊断界值,CK-MB、cTnI和Myo联合检测的灵敏度最高,为47.33%,高于各单项检测、任意两项联检的灵敏度,而单独检测cTnI特异度较高,可达99.37%。结论院外急救患者为胸痛的老年男性患者时,提示AMI的可能性更大。急救院外使用POCT检测CK-MB、Myo、cTnI可以较迅速地对AMI进行初步判断,可以准确地排除AMI。当院外急救胸痛患者的心肌损伤标志物表现正常时,也需要联合心电图结果进行判断。Objective To evaluate the predictive value of point-of-care testing(POCT)of creatine kinase-MB(CKMB),cardiac troponin I(cTnI),and myoglobin(Myo)in the early diagnosis of acute myocardial infarction(AMI)during emergency treatment.Methods 487 patients with the suspicious diagnosis of AMI,321 males and 166 females,aged(61.71±16.10)(16~95),underwent electrocardiography,and testing of CK-MB,cTnI,and Myo by POCT method at the emergency scen,and then were divided into 2 groups:AMI group(n=169,34.7%)and non-AMI group(n=318,65.3%).The negative predictive value(NPV)and positive predictive value(PPV)of these markers were calculated.with the cutoff value given by the test kit.Results Among the 487 patients with chest pain,169(34.7%)of them were finally diagnosed with AMI.The proportion of males in the AMI group was 76.33%,significantly higher than that of the non-AMI patients(60.38%).The proportion of Q wave abnormality in the AMI group was 67.46%,significantly higher than that in the non-AMI group(0.31%,P<0.05).The proportion of ST segment abnormality in the AMI group was 67.46%,significantly higher than that in the non-AMI group(0,P<0.05).Among the AMI patients,80 of them were found with abnormal levels of myocardial markers.The age of the normal myocardial infarction serum markers group was(59.44±11.86)years old,significantly younger than that of the abnormal myocardial infarction serum markers group[(64.94±14.45)years old,P<0.05].The proportion of pathological Q wave in the abnormal myocardial infarction serum markers group was 58.75%,significantly lower than that in the normal myocardial infarction serum markers group(75.28%,P<0.05),and the proportion of ST segment elevation in the abnormal myocardial infarction serum markers group was 75.00%,significantly lower than that in the normal myocardial infarction serum markers group(94.38,P<0.05).The sensitivity of combo test of CK-MB,cTnI,and Myo was 47.33%,significantly higher than those of every single test and any two combo tests of CK-MB,cTnI and Myo.However,In the si

关 键 词：院外急救 胸痛 心肌三联检测 首次使用 提高生存率 

分 类 号：R542.22[医药卫生—心血管疾病]