床旁快速联合测定肌钙蛋白I、肌酸激酶同工酶和肌红蛋白诊断急性心肌梗死的临床价值
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摘要
目的探讨分析肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)和肌红蛋白(MB)的床旁快速联合检测在诊断急性心肌梗死(AMI)中的临床应用价值。方法将2013年1月至2014年8月的138例于3h内胸痛发作的急诊患者作为研究对象,按照AMI的诊断标准将其分为AMI组(观察组)和非AMI组(对照组)。采用Judkins方法,将6F冠状动脉造影导管经右股动脉实施动脉造影,并对已确诊的患者使用冠状动脉介入方法(PCI)进行治疗。定时抽取静脉血,并定量测定cTnI、CK-MB及MB的水平。结果两组患者在各时间段测定的结果显示,观察组患者血清cTnI、CK-MB和MB的水平均明显高于对照组(P<0.05)。联合检测cTnI、CK-MB和MB对AMI诊断的敏感度为97.2%,特异性为88.3%,与分别检测三项指标的敏感度和特异性(分别为86.8%、81.3%、84.2%;78.6%、74.6%和72.5%)相比均明显增高,差异均有统计学意义(P<0.05)。结论床旁快速联合检测cTnI、CK-MB和MB的水平在AMI诊断的敏感度和特异性方面均明显提高,与冠状动脉的造影结果一致,可在临床上推广应用。
Objective To investigate and analyze the clinical application value of bedside rapid combined detection of cardiac troponinⅠ(cTnI),creatine kinase(CK-MB)and myohemoglobin(MB)for the diagnosis of acute myocardial infarction(AMI).Methods 138 emergency cases with chest pain onset less than 3hin our hospital from January 2013 to August 2014 were selected as the research subjects and divided into the AMI group(observation group)and non-AMI group(control group)according to the diagnostic criteria of AMI.The Judkins method was adopted to conduct the coronary arteriongraphy via right femoral artery with 6Fcoronary arteriography catheter.The diagnosed AMI patients were treated by adopting percutaneous coronary intervention(PCI).The timing extraction of venous blood samples was performed for detecting the serum levels of cTnI,CK-MB and MB.Results The detection results at various time periods in the two groups showed that serum cTnI,CK-MB and MB levels in the observation group were significantly higher than those in the control group(P<0.05).The sensitivity and the specificity in the combined detection of serum cTnI,CK-MB and MB levels for diagnosing AMI were 97.2% and 88.3% respectively,which were significantly higher than 86.8%,81.3%,84.2% and 78.6%,74.6%,72.5%in the single detection of these 3indicators respectively,the differences were statistically significant(P<0.05).Conclusion The bedside rapid combined detection of cTnI,CK-MB and MB can significantly increase the sensitivity and specificity for diagnosing AMI,has the results consistent to that of the coronary angiography and can be promoted and applied in clinic.
Objective To investigate and analyze the clinical application value of bedside rapid combined detection of cardiac troponinⅠ(cTnI),creatine kinase(CK-MB)and myohemoglobin(MB)for the diagnosis of acute myocardial infarction(AMI).Methods 138 emergency cases with chest pain onset less than 3hin our hospital from January 2013 to August 2014 were selected as the research subjects and divided into the AMI group(observation group)and non-AMI group(control group)according to the diagnostic criteria of AMI.The Judkins method was adopted to conduct the coronary arteriongraphy via right femoral artery with 6Fcoronary arteriography catheter.The diagnosed AMI patients were treated by adopting percutaneous coronary intervention(PCI).The timing extraction of venous blood samples was performed for detecting the serum levels of cTnI,CK-MB and MB.Results The detection results at various time periods in the two groups showed that serum cTnI,CK-MB and MB levels in the observation group were significantly higher than those in the control group(P<0.05).The sensitivity and the specificity in the combined detection of serum cTnI,CK-MB and MB levels for diagnosing AMI were 97.2% and 88.3% respectively,which were significantly higher than 86.8%,81.3%,84.2% and 78.6%,74.6%,72.5%in the single detection of these 3indicators respectively,the differences were statistically significant(P<0.05).Conclusion The bedside rapid combined detection of cTnI,CK-MB and MB can significantly increase the sensitivity and specificity for diagnosing AMI,has the results consistent to that of the coronary angiography and can be promoted and applied in clinic.
引文
[1]孟岩,杨翠红,郝彦平,等.心肌标志物在临床使用现状分析[J].中国民康医学,2012,24(9):1101-1103.
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[6]Mendis S,Thygesen K,Kuulasmaa K,et al.World Health Organization definition of myocardial infarction:2008-09revision[J].Int J Epidemiol,2011,40(1):139-146.
[7]Wu AH,Panteghini M,Apple FS,et al.Biochemical markers of cardiac damage:from traditional enzymes to cardiac-specific proteins[J].Scand J Clin Lab Invest,1999,59(S230):74-82.
[8]梁志洪,邓家德,古文鑫,等.肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)浓度监测在诊断急性心肌梗死(AMI)中的作用[J].中国医药指南,2013,11(19):14-15.
[9]龚国忠,蒲泽晏,刘友迎,等.CK-MB质量法与超敏肌钙蛋白T联合测定在急性心肌梗死中的临床价值比较[J].西部医学,2013,25(8):1251-1253.
[10]Antman EM.Decision making with cardiac troponin tests[J].N Engl J Med,2002,346(26):2079-2081.
[11]Mc Cord J,Nowak RM,Mc Cullough PA,et al.Ninetyminute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I[J].Circulation,2001,104(13):1483-1488.
[12]李挺,伍华,黄杰雄,等.生化标志物的检测对判定急性心肌梗死溶栓后冠脉再通的临床价值[J].热带医学杂志,2009,9(1):67-69,66.
[13]夏杰.快速检测血浆心肌脂肪酸结合蛋白(H-FABP)在急性心肌梗死早期诊断中的临床价值[J].中国民康医学,2014,26(7):61-62.
[14]de Lemos JA,Morrow DA,Bentley JH,et al.The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes[J].N Engl J Med,2001,345(14):1014-1021.
[2]李抒玮,陈荣健,陈杰文,等.院前心肌标志物即时定性检测在急性心肌梗死早期诊断中的应用[J].广东医学,2012,33(23):3566-3567.
[3]Asada J,Tsuji H,Iwasaka T,et al.Usefulness of plasma brain natriuretic peptide levels in predicting dobutamineinduced myocardial ischemia[J].Am J Cardiol,2004,93(6):702-704.
[4]Zaninotto M,Altinier S,Lachin M,et al.Strategies for the early diagnosis of acute myocardial infarction using biochemical markers[J].Am J Clin Pathol,1999,111(3):399-405.
[5]黄海樱,陈波,周强,等.急性心肌梗死实验室早期诊断指标联合应用的价值[J].广东医学,2013,34(14):2165-2168.
[6]Mendis S,Thygesen K,Kuulasmaa K,et al.World Health Organization definition of myocardial infarction:2008-09revision[J].Int J Epidemiol,2011,40(1):139-146.
[7]Wu AH,Panteghini M,Apple FS,et al.Biochemical markers of cardiac damage:from traditional enzymes to cardiac-specific proteins[J].Scand J Clin Lab Invest,1999,59(S230):74-82.
[8]梁志洪,邓家德,古文鑫,等.肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)浓度监测在诊断急性心肌梗死(AMI)中的作用[J].中国医药指南,2013,11(19):14-15.
[9]龚国忠,蒲泽晏,刘友迎,等.CK-MB质量法与超敏肌钙蛋白T联合测定在急性心肌梗死中的临床价值比较[J].西部医学,2013,25(8):1251-1253.
[10]Antman EM.Decision making with cardiac troponin tests[J].N Engl J Med,2002,346(26):2079-2081.
[11]Mc Cord J,Nowak RM,Mc Cullough PA,et al.Ninetyminute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I[J].Circulation,2001,104(13):1483-1488.
[12]李挺,伍华,黄杰雄,等.生化标志物的检测对判定急性心肌梗死溶栓后冠脉再通的临床价值[J].热带医学杂志,2009,9(1):67-69,66.
[13]夏杰.快速检测血浆心肌脂肪酸结合蛋白(H-FABP)在急性心肌梗死早期诊断中的临床价值[J].中国民康医学,2014,26(7):61-62.
[14]de Lemos JA,Morrow DA,Bentley JH,et al.The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes[J].N Engl J Med,2001,345(14):1014-1021.