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目的评价肌钙蛋白I(TnI)、肌红蛋白(Myo)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、超敏C-反应蛋白(hs-CRP)、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH),用于急性心肌梗死(AMI)和心绞痛的鉴别诊断效率。方法AMI组92例,心绞痛组96例。TnI和Myo测定用化学发光法,CK、CKMB、AST、LDH、HBDH用酶动力连续监测法,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、特异性等评价指标。结果AMI发生<6 h的ROC曲线下面积依次为Myo 0.92、TnI 0.92、CK 0.81、CKMB 0.81、AST0.78h、s-CRP 0.73、LDH 0.70、HBDH 0.65;AMI发生>6 h依次为TnI 0.93、AST 0.86、CKMB0.84、CK 0.80、Myo 0.76、HBDH 0.72、LDH 0.70h、s-CRP 0.56;AMI发生<6 h的敏感性和特异性分别为TnI 0.87和0.90、Myo 0.96和0.78、CK 0.83和0.67、CKMB 0.65和0.82、AST 0.69和0.77、LDH 0.64和0.73、HBDH 0.71和0.65、hs-CRP 0.64和0.82。阳性似然比最高为TnI 8.8,阴性似然比最低为Myo 0.05。结论诊断AMI效率较高的项目依次为TnI、Myo、CKMB、CK,Myo在AMI发作6 h以后的诊断效率降低,AST、LDH、HBDH仍有诊断意义。
Objective To evaluate the effects of TnI, Myo, CK, CKMB, hs-CRP, aspartate Aminotransferase (AST), lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (HBDH) for the differential diagnosis of acute myocardial infarction (AMI) and angina pectoris. Methods AMI group 92 cases, angina pectoris group 96 cases. TnI and Myo determination using chemiluminescence, CK, CKMB, AST, LDH, HBDH with continuous monitoring of enzyme kinetics, hs-CRP enhanced latex immunoturbidimetric method. Subjects operating characteristic curve (ROC) analysis of the area under the curve and sensitivity, specificity and other indicators. Results The areas under the ROC curve of <6 h after AMI were Myo 0.92, TnI 0.92, CK 0.81, CKMB 0.81, AST 0.78h, s-CRP 0.73, LDH 0.70, HBDH 0.65, AMI> 6 h followed by TnI 0.93, AST 0.86, CKMB 0.84, CK 0.80, Myo 0.76, HBDH 0.72, LDH 0.70h and s-CRP 0.56 respectively. The sensitivity and specificity of <6 h AMI were TnI 0.87 and 0.90, Myo 0.96 and 0.78, CK 0.83 And 0.67, CKMB 0.65 and 0.82, AST 0.69 and 0.77, LDH 0.64 and 0.73, HBDH 0.71 and 0.65, hs-CRP 0.64 and 0.82, respectively. Positive likelihood ratio up to TnI 8.8, negative likelihood ratio of the lowest Myo 0.05. Conclusions The items with high efficiency of diagnosis of AMI are TnI, Myo, CKMB, CK and Myo. The diagnostic efficiency of AMI after 6 hours of onset of AMI is reduced, and the diagnostic value of AST, LDH and HBDH still have significance.