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目的评价几种心肌损伤标志物用于急性心肌梗死(AMI)与心绞痛的鉴别诊断效率。方法选择解放军第306医院2002年11月至2004年11月收治的住院患者188例,其中AMI组92例,心绞痛组96例。肌钙蛋白I(TnI)和肌红蛋白(Myo)测定用化学发光法,肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH)用酶动力连续监测法,超敏C-反应蛋白(hs-CRP)用增强胶乳免疫浊度法。采用受试者操作特性曲线(ROC)分析曲线下面积和敏感度、特异性。结果AMI发生≤6h的ROC曲线下的面积依次为Myo0·92、TnI0·92、CK0·81、CK-MB0·81、AST0·78、hs-CRP0·73、LDH0·70、HBDH0·65;AMI发生>6h依次为TnI0·93、AST0·86、CK-MB0·84、CK0·80、Myo0·76、HBDH0·72、LDH0·70、hs-CRP0·56;AMI发生≤6h的敏感性和特异性TnI0·87和0·90、Myo0·96和0·78、CK0·83和0·67、CK-MB0·65和0·82、AST0·69和0·77、LDH0·64和0·73、HBDH0·71和0·65、hs-CRP0·64和0·82。阳性似然比最高为TnI8·8,阴性似然比最低为Myo0·05。结论AMI与心绞痛鉴别诊断效率依次为TnI、Myo、CK-MB、CK;Myo在AMI发作6h以后的诊断效率降低,AST、LDH、HBDH仍有意义。
Objective To evaluate the differential diagnosis of several myocardial injury markers for acute myocardial infarction (AMI) and angina pectoris. Methods A total of 188 inpatients admitted to the 306th Hospital of PLA from November 2002 to November 2004 were selected, including 92 AMI patients and 96 angina pectoris patients. TnI and Myo were measured by chemiluminescence, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST), lactate Hydrogenase (LDH), α-hydroxybutyrate dehydrogenase (HBDH) using enzyme kinetic continuous monitoring method, high sensitivity C-reactive protein (hs-CRP) with enhanced latex immunoturbidimetry. The receiver operating characteristic curve (ROC) was used to analyze the area under the curve and the sensitivity and specificity. Results The area under the ROC curve of AMI ≤6h was Myo0.92, TnI0.92, CK0.81, CK-MB0.81, AST0.78, hs-CRP0.73, LDH0.70, HBDH0.65 and AMI 6h followed by TnI0 · 93, AST0 · 86, CK-MB0 · 84, CK0 · 80, Myo0 · 76, HBDH0 · 72, LDH0 · 70, hs-CRP0 · 56; Sensitivity and specificity of AMI ≤6h Sexes TnI0.87 and 0.90, Myo0.96 and 0.78, CK0.83 and 0.67, CK-MB0.65 and 0.82, AST0.69 and 0.77, LDH0.64 and 0.73 , HBDH0.71 and 0.65, hs-CRP0.64 and 0.82. The highest positive likelihood ratio was TnI8 · 8, and the lowest negative likelihood ratio was Myo0.05. Conclusion The diagnostic efficiency of AMI and angina pectoris were TnI, Myo, CK-MB and CK respectively. The diagnostic efficiency of Myo in 6h after AMI was decreased, while AST, LDH and HBDH still had significance.