摘要
目的探讨用化学发光法检测肌红蛋白（MYO）、肌酸激酶同工酶（CK—MB）质量、肌钙蛋白（CTnI）对急性心肌梗死（AMI）的诊断价值。方法以65例AMI临床确诊病例为研究组，65例不稳定型心绞痛（UAP），65例其他心脏病患者和50例健康体检为对照组，于不同时间用化学发光法检测MYO、CK—MB、CTnI含量，比较诊断AMI的敏感性和特异性，并随访AMI组患者心脏病性猝死及心绞痛事件发生情况，确定联合检测和独立检测的最佳时间具有的不同诊断价值。结果AMI组（症状6～24h）CTnI、MYO、CK—MB均显著高于对照组，具有显著性差异（P〈0．01）。在症状发生后的2—6h采样分析，CTnI、MYO联合诊断AMI的敏感性和特异性分别是81．8％、87．8％；89．4％、50．6％，MYO有高的阴性预示值。在症状发生后的6—12h采样分析，CTnI、MYO、CK—MB联合诊断AMI的敏感性和特异性分别是95．4％、99．6％；98．9％、80．6％；90．6％、80．9％。有较高的敏感性和特异性。在症状发生后的12～24h采样分析，cTnI、CK—MB联合诊断AMI敏感性和特异性分别为100％、100％；96．9％、87．3％，可达到最佳敏感性和特异性。在症状发生后的24—72h采样分析，cTnI诊断AMI的敏感性和特异性分别是89．5％和100％。结论联合检测MYO、CK—MB、CTnI能够更准确的诊断AMI，不同时间段各项指标的敏感性和特异性差异较大，因此根据不同的选择可提高AMI的诊断率和制定最佳治疗方案。
Objective To investigate the diagnostic value and clinical significance of serum tumor markers CTnI, MYO and CK - MB in patients with acute myocardial infarction（ AMI）. Methods The serum levels of MYO, CK - MB and CTnI were determined by chemiluminescence immunoassay（CLIA） in 65 AMI patients, 65 patients with unstable angina peetoris （ UAP）, 65 patients with other myocardial diseases and 50 healthy subjects. Different groups were compared and the occurrence of sudden cardiac death and angina pectoris in AMI patients were foliowed - up. Results The levels of MYO, CK - MB, CTnI in AM1 groups were significantly higher than those in other groups（ P 〈 0.01 ）. The sensitivity and specificity of the combined detection of CTnI and MYO for the diagnosis of AMI were 81.8% and 87.8%, 89.4% and 50.6% respectively and myoglobin showed high negative predictive value when blood was sampled at 2 - 6 hours after the onset of AMI. The sensitivity and specificity of the combined detection of CTnI, MYO and CK - MB for the diagnosis of AMI were 95.4% and 99.6%, 98.9% and 80.6%, 90.6% and 80. 9% respectively when sampled at 6 - 12 hours after the onset. The sensitivity and specificity of combined detection of cTnI and CK - MB were 100% and 100%, 96.9% and 87.3% respectively when sampled at 12 - 24 hours after symptom onset. The sensitivity and specificity of cTnl were 89.5% and 100% respectively for sampling over 24-72 hours after symptom onset. Conclusion The results indicate that the combined use of MYO, CK - MB and CTnI is of high accuracy for the diagnosis of AMI. Differences in the sensitivity and specificity of the detection at different time - point after the onset of AM1 provides important information for the establishment of the diagnosis and therapeutic strategy for the patients.
出处
《临床和实验医学杂志》
2009年第9期18-19,22,共3页
Journal of Clinical and Experimental Medicine
