多层螺旋CT结合心肌三项检查在急性胸痛病因诊断中的应用  

Application of multi-slice spiral CT combined with three myocardial markers in the diagnosis of acute chest pain causes

作　　者：张东勤 高鸿翼[1] 孙建平 王喜云 谷琳琳[1] 师猛[1] Zhang Dongqin;Gao Hongyi;Sun Jianping;Wang Xiyun;Gu Linlin;Shi Meng(Department of Emergency,Affiliated Hospital of Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院急诊科,济宁272000

出　　处：《中国医师杂志》2023年第11期1697-1700,1706,共5页Journal of Chinese Physician

基　　金：山东省医药卫生科技发展项目(202010000964)。

摘　　要：目的探讨多层螺旋CT(MSCT)结合心肌三项检查在急性胸痛患者病因诊断中的价值。方法回顾性选取济宁医学院附属医院2020年1月至2020年12月收治的120例急性胸痛患者,所有患者入院时均接受了MSCT影像学检查,并进行了血清肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、肌红蛋白(MYO)水平检查,以最终临床确诊结果作为判断金标准绘制2×2四格表,计算MSCT、CK-MB、cTnI、MYO在急性胸痛病因诊断中的价值。结果纳入的120例急性胸痛患者,经最终临床诊断,确诊冠心病急性发作75例(62.50%)、主动脉夹层16例(13.33%)、肺动脉栓塞29例(24.17%);MSCT诊断冠心病的符合率为86.67%(65/75),诊断主动脉夹层的符合率为12/16,诊断肺动脉栓塞的符合率为75.86%(22/29);冠心病组患者的血清CK-MB、cTnI、MYO测定值均明显高于主动脉夹层组、肺动脉栓塞组,差异均有统计学意义(均P<0.05);主动脉夹层组、肺动脉栓塞组患者的血清CK-MB、cTnI、MYO测定值比较,差异无统计学意义(均P>0.05);CK-MB、cTnI、MYO鉴别诊断急性胸痛患者中冠心病和非冠心病患者的灵敏度分别为93.33%、85.33%、89.33%,特异度分别为73.33%、80.00%、77.78%,ROC曲线下面积分别为0.833、0.826、0.836。结论MSCT在急性胸痛患者诊断中能较好地鉴别诊断冠心病、主动脉夹层、肺动脉栓塞,而心肌三项能更好分辨冠心病和非冠心病患者,因此临床对急性胸痛患者进行诊断时可将MSCT与心肌三项结合考察,有利于早期临床确诊。Objective To investigate the value of multi-slice spiral CT(MSCT)combined with three myocardial markers in the diagnosis of acute chest pain etiology.Methods A retrospective study was conducted on 120 patients with acute chest pain admitted to the Affiliated Hospital of Jining Medical University from January 2020 to December 2020.All patients underwent MSCT imaging examination upon admission,and serum creatine kinase isoenzyme MB(CK-MB),troponin I(cTnI),and myoglobin(MYO)levels were also tested.The final clinical diagnosis was used as the judgment standard to draw a 2×2 four-square table,and calculate the value of MSCT,CK-MB,cTnI,and MYO in the diagnosis of acute chest pain etiology.Resultsl Among the 120 acute chest pain patients included,75 were diagnosed with acute coronary syndrome(62.50%),16 with aortic dissection(13.33%),and 29 with pulmonary embolism(24.17%).The coincidence rate of MSCT diagnosis of coronary heart disease was 86.67%(65/75),the diagnosis of aortic dissection coincidence rate was 12/16,and the diagnosis of pulmonary embolism coincidence rate was 75.86%(22/29).The serum CK-MB,cTnI,and MYO levels in the coronary heart disease group were significantly higher than those in the aortic dissection group and pulmonary embolism group,and the differences were statistically significant(all P<0.05).There was no significant difference in serum CK-MB,cTnI,and MYO levels between the aortic dissection group and pulmonary embolism group(all P>0.05).The sensitivity of CK-MB,cTnI,and MYO in the differential diagnosis of acute chest pain patients with coronary heart disease and non-coronary heart disease were 93.33%,85.33%,and 89.33%,respectively,and the specificity were 73.33%,80.00%,and 77.78%,respectively.The areas under the receiver operating characteristic(ROC)curve were 0.833,0.826,and 0.836,respectively.Conclusions MSCT can better identify coronary heart disease,aortic dissection,and pulmonary embolism in patients with acute chest pain,while the three myocardial markers can better distinguish patients w

关 键 词：胸痛 体层摄影术 螺旋计算机 肌酸激酶 MB型 肌钙蛋白I 肌红蛋白 

分 类 号：R816.2[医药卫生—放射医学] R54[医药卫生—临床医学]