论文部分内容阅读
目的探讨床边快速心肌肌钙蛋白I(cTnI)、肌红蛋白(Myo)和肌酸激酶同功酶(CK-MB)联合检测对急诊胸痛患者早期危险度分层的临床价值。方法采用美国博适-Triage干式快速定量心肌梗死/心衰诊断仪,对急诊的260例急性胸痛患者,采静脉血床边动态测定cTnI、Myo和CK-MB含量,并结合临床症状、心电图动态变化,对患者进行缺血风险评价,并随访cTnI阳性患者病死事件发生情况。结果 260例急性胸痛病例,首次危险分层高危组47例,中低危组213例,就诊后0h时点两组间cTnI和CK-MB含量具有显著性差异(P<0.05),Myo含量具有非常显著性差异(P<0.01)。基于心脏标志物变化的二次危险分层,确诊为AMI者106例,非AMI者154例。Myo、CK-MB、cTnI及三项联合诊断AMI的敏感性和特异性在胸痛发作后0～4h时间段分别是49.5%、60.0%;27.2%、92.6%;28.2%、100.0%;35.0%、84.2%;在4～8h时间段分别是70.7%、42.9%;68.3%、82.9%;75.6%、94.3%;71.5%、73.4%;在12h后分别是96.3%、36.7%;96.3%、73.3%;96.3%、86.7%;96.3%、65.6%。在短期随访期间(平均为28.5d),cTnI阳性和阴性患者的病死率分别为12.6%(13/103)和3.0%(4/134),P<0.005。结论床边快速cTnI、Myo和CK-MB联合检测,可提高对缺血性胸痛早期诊断的敏感性和特异性,有助于急性胸痛危险度分层与处理。
Objective To investigate the clinical value of cTnI, Myo and CK-MB in the detection of early risk stratification in patients with acute chest pain. Methods 260 cases of acute chest pain in emergency were diagnosed by Bochang-Tiant dry-fast quantitative myocardial infarction / heart failure diagnostic instrument. The cTnI, Myo and CK-MB contents were measured by bedside in venous blood. The clinical symptoms, electrocardiogram Dynamic changes in patients with ischemic risk assessment, and follow-up cTnI-positive patients with the incidence of death. Results There were significant differences in cTnI and CK-MB contents between the two groups (P <0.05), Myo content was found in 260 cases of acute chest pain, the first risk stratified high risk group of 47 cases, middle and low risk group of 213 cases, Very significant difference (P <0.01). Based on the secondary risk stratification of changes in cardiac markers, 106 patients were diagnosed with AMI and 154 with non-AMI. The sensitivity and specificity of Myo, CK-MB, cTnI and three combined diagnoses of AMI were 49.5%, 60.0%, 27.2%, 92.6%, 28.2%, 100.0%, 35.0% , 84.2% in the period of 4 ~ 8h, respectively, which were respectively 70.7%, 42.9%, 68.3%, 82.9%, 75.6%, 94.3%, 71.5%, 73.4% 73.3%; 96.3%, 86.7%; 96.3%, 65.6%. In the short-term follow-up period (mean 28.5 days), the mortality rates of cTnI-positive and -negative patients were 12.6% (13/103) and 3.0% (4/134), respectively, P <0.005. Conclusion The rapid detection of cTnI, Myo and CK-MB at bedside can improve the sensitivity and specificity of early diagnosis of ischemic chest pain and contribute to the stratification and treatment of acute chest pain.