心肌肌球蛋白结合蛋白-C对发病早期急性心肌梗死的临床诊断价值与意义  

Clinical Value and Significance of Cardial Myosin Binding Protein-C in the Diagnosis of Early Onset Acute Myocardial Infraction

作　　者：卢青 侯攀 章雪平 刘辉 丁世芳 LU Qing;HOU Pan;ZHANG Xueping;LIU Hui;DING Shifang(Department of Cardiovascular Medicine,General Hospital of Central Theater Command,Wuhan Hubei 430070,China)

机构地区：[1]中部战区总医院心血管病内科,湖北武汉430070 [2]中部战区总医院医疗保障中心

出　　处：《联勤军事医学》2024年第8期688-693,共6页Military Medicine of Joint Logistics

摘　　要：目的 分析血清心肌肌球蛋白结合蛋白C(cardiac myosin binding protein C,cMyBP-C)在急性心肌梗死(acute myocardial infraction,AMI)患者发病早期的表达水平,探讨其对发病早期AMI诊断与鉴别诊断的临床价值和意义。方法 选择2021-10/2022-10月在作者医院心血管病内科收治的发病早期AMI患者99例,其中急性非ST段抬高型心肌梗死(non ST-segment elevation myocardial infraction,NSTEMI)患者51例(NSTEMI组),急性ST段抬高型心肌梗死(ST-segment elevation myocardial infraction,STEMI)患者48例(STEMI组);选取经冠状动脉造影排除冠状动脉粥样硬化性心脏病的同期住院患者48例作为对照组。比较3组患者入院时、入院3 h、入院12 h的cMyBP-C水平,并与同期所测的血清肌钙蛋白T(cardiac troponin T,cTnT)进行比较。用受试者工作特征(receiver operating characteristic,ROC)曲线分析不同时间点cMyBP-C诊断AMI及鉴别诊断STEMI与NSTEMI的效能。结果 cMyBP-C在发病早期AMI患者入院时即可升高,入院3 h显著升高,入院12 h则明显下降;与cTnT比较,cMyBP-C升高更早,峰值更早,同时消退也更迅速。ROC曲线分析显示,在诊断NSTEMI时,各时间点cMyBP-C ROC曲线的曲线下面积(area under the curve,AUC)均优于同期cTnT;在诊断STEMI时,入院时和入院3 h所测cMyBP-C的诊断效能优于同期cTnT,入院12 h所测cMyBP-C的诊断效能不如同期cTnT;在STEMI和NSTEMI的鉴别诊断中,入院时及入院3 h所测cMyBP-C优于同期cTnT;但入院12 h的cMyBP-C诊断效能不如cTnT。结论 发病早期AMI患者的cMyBP-C水平入院时即升高,入院3 h明显升高,入院12 h显著下降,与cTnT相比,cMyBP-C不仅可以作为早期诊断AMI灵敏度更高的生物标志物,还有利于早期STEMI和NSTEMI的鉴别诊断。Objective To analyze the expression level of serum cardiac myosin binding protein C(cMyBP-C) in early onset acute myocardial infarction(AMI) patients,and to explore its clinical value and significance in diagnosis and differential diagnosis of early onset AMI.Methods A total of 99 early onset AMI patients who were admitted to department of cardiovascular medicine of author′s hospital from October 2021 to October 2022 were selected,including 51 non ST-segment elevation myocardial infarction(NSTEMI) patients(NSTEMI group) and 48 ST-segment elevation myocardial infarction(STEMI) patients(STEMI group);and 48 hospitalized patients without coronary atherosclerotic heart disease were selected as the control group.The levels of cMyBP-C were compared among the three groups at admission,3h and 12h after admission respectively,and compared with the serum cardiac troponin T(cTnT) measured at the same time.The efficacy of cMyBP-C in the diagnosis of AMI and the differential diagnosis of STEMI and NSTEMI at different timing were analyzed by receiver operating characteristic(ROC) curve.Results cMyBP-C increased at admission in patients with early onset AMI and significantly increased 3h after admission,and significantly decreased at 12h after admission;compared with cTnT,cMyBP-C increased earlier,peaked earlier and subsided more rapidly.ROC curve analysis showed that during the diagnosis of NSTEMI,the ROC area under curve(AUC) of cMyBP-C at each timing was better than that of cTnT.In the diagnosis of STEMI,the diagnostic efficacy of cMyBP-C measured at admission and 3h after admission was superior to that of cTnT,the diagnostic efficacy of cMyBP-C measured at 12h after admission was inferior to that of cTnT.In the differential diagnosis of STEMI and NSTEMI,cMyBP-C was superior to cTnT measured at admission and 3h after admission;however,the diagnostic effective of cMyBP-C was less than cTnT at 12h after admission.Conclusion The level of cMyBP-C in patients with early onset AMI increases immediately upon admission,significantl

关 键 词：急性心肌梗死 心肌肌球蛋白结合蛋白C 肌钙蛋白T 急性非ST段抬高型心肌梗死 急性ST段抬高型心肌梗死 

分 类 号：R542.2[医药卫生—心血管疾病]