急性心肌梗死患者早期预警指标研究进展  

Research progress on early warning indicators of acute myocardial infarction

作　　者：王艳翠 Wang Yancui(Zhangdian District People’s Hospital,Zibo,Shandong 255000,China)

机构地区：[1]山东省淄博市张店区人民医院,山东淄博255000

出　　处：《首都食品与医药》2025年第10期15-19,共5页Capital Food Medicine

摘　　要：急性心肌梗死(AMI)是全球范围内导致人口死亡的主要原因之一,其早期诊断和及时治疗对于改善患者预后至关重要。传统的心肌梗死生物标志物肌酸激酶同工酶(CK-MB)和肌红蛋白(Mb)由于其特异性低、诊断窗口期短等局限性,在AMI早期诊断中的地位逐渐下降,而肌钙蛋白(cTn)因其高特异性和敏感性已成为AMI诊断的“金标准”,高敏心肌肌钙蛋白(hs-cTn)的出现则进一步提高了cTn的诊断准确性,使其能够更早地检测到微小心肌损伤,并在早期诊断、评估再灌注治疗效果、风险分层和预后判断等方面展现出显著的临床价值。然而hs-cTn并非完美无缺,其升高也可见于慢性肾病、心力衰竭等非AMI疾病,且在AMI极早期阶段的敏感性仍有待提高,所以其检测结果也易受溶血、脂血等因素干扰,故需医务人员结合临床症状、心电图等指标进行综合判断。为克服单一标志物的局限性,多种新型生物标志物联合应用的研究逐渐兴起,心脏型脂肪酸结合蛋白(H-FABP)升高速度比cTn更快,其用于AMI极早期诊断,但由于特异性较低,常与hs-cTn联合使用以提高诊断准确性,而Copeptin作为神经内分泌标志物,主要反映交感神经激活状态,与hs-cTn联合应用可提高早期诊断灵敏度和预后判断准确性。炎症标志物高敏C反应蛋白(hs-CRP)和白细胞介素-6(IL-6)可以反映患者的炎症反应程度,其与心肌标志物联合应用可提高AMI风险评估和预后判断的准确性。此外,心肌特异性microRNA(如miR-208a、miR-499)、可溶性CD40配体(sCD40L)、生长分化因子-15(GDF-15)等新型生物标志物也展现出良好的诊断和预后判断价值,但其临床应用仍处于研究阶段,需要进行大规模临床验证。Acute myocardial infarction(AMI)is one of the leading causes of death worldwide,and its early diagnosis and timely treatment are essential to improve the prognosis of patients.The traditional myocardial infarction biomarkers creatine kinase isoenzyme(CK-MB)and myoglobin(Mb)have gradually declined in the early diagnosis of AMI because of their low specificity and short diagnostic window period,while troponin(cTn)has become the“gold standard”for the diagnosis of AMI because of its high specificity and sensitivity.The presence of high-sensitivity troponin(hs-cTn)further improves the diagnostic accuracy of cTn,making it possible to detect minor myocardial injury earlier,and showing significant clinical value in early diagnosis,evaluation of reperfusion therapy,risk stratification and prognosis.However,hs-cTn is not perfect,its elevation can also be seen in chronic kidney disease,heart failure and other non-AMI diseases,and its sensitivity in the very early stage of AMI still needs to be improved,so its detection results are also vulnerable to hemolysis,lipemia and other factors,so it needs medical staff to make a comprehensive judgment combined with clinical symptoms,electrocardiogram and other indicators.In order to overcome the limitations of a single biomarker,the study of combined application of multiple new biomarkers is gradually rising.Heart-type fatty acid-binding protein(H-FABP)increases faster than cTn,which is used for the very early diagnosis of AMI,but because of its low specificity,it is often combined with hs-cTn to improve the diagnostic accuracy.Copeptin,as a neuroendocrine marker,mainly reflects the activation of sympathetic nerve,and combined with hs-cTn can improve the sensitivity of early diagnosis and the accuracy of prognosis.Inflammatory markers such as high-sensitivity C-reactive protein(hs-CRP)and interleukin-6(IL-6)can reflect the degree of inflammatory response in patients,and their combination with myocardial markers can improve the accuracy of risk assessment and prognosis of AMI.In

关 键 词：急性心肌梗死 早期诊断 预警指标 

分 类 号：R542.22[医药卫生—心血管疾病]