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目的探讨肌酸激酶同工酶(CK-MB)、肌红蛋白(Myo)、心肌肌钙蛋白T(cTnI)联合检测对急性心肌梗死(AMI)及心力衰竭(HF)患者的临床诊断及应用价值。方法选择2012年6月—2013年12月收治的AMI患者45例、HF患者78例,35例健康正常者予以对照,采用电化学发光免疫方法定量测定Myo、cTnI,免疫抑制法测定CK-MB,根据相关心功能分级标准将HF患者分为Ⅰ~Ⅳ级,分析对比二组检测结果并评估三种标志物的灵敏度和特异性。结果 AMI组患者和HF组患者血清采样Myo、cTnI和CK-MB明显高于健康对照组,在发病后2h,Myo的敏感性达到61.34%,特异性57.32%;发病后4h,Myo、CK-MB和cTnI的敏感性分别为87.42%、53.48%和44.31%,特异性分别为73.13%、80.03%、81.17%;发病后6h,Myo、cTnI、CK-MB的敏感性均为100%,特异性分别为87.24%、90.19%、95.34%;cTnI+Myo+CK-MB2项或3项联合检测AMI患者时,特异性明显提高。Ⅰ~Ⅳ级的HF患者间CK-MB、Myo、cTnI水平比较差异均有统计学意义(P<0.05)。结论 Myo、cTnI、CK-MB联合检测在心功能分级以及AMI早期诊断敏感性及特异性良好,其中cTnI和Myo可用于临床预测心肌再梗死的风险。
Objective To investigate the clinical diagnosis and application of combined detection of CK-MB, Myo and cTnI in patients with acute myocardial infarction (AMI) and heart failure (HF) value. Methods 45 patients with AMI, 78 HF patients and 35 healthy controls were enrolled in this study. The levels of Myo and cTnI were determined by electrochemiluminescence immunoassay. CK-MB was measured by immunosuppression The HF patients were divided into Ⅰ ~ Ⅳ grade according to the related cardiac function grading standards. The results of the two groups were compared and the sensitivity and specificity of the three markers were evaluated. Results Myo, cTnI and CK-MB in patients with AMI and HF were significantly higher than those in healthy controls (P <0.05). After 2 hours, the sensitivity and specificity of Myo were 61.34% and 57.32% The sensitivity of MB and cTnI were 87.42%, 53.48% and 44.31%, respectively, the specificity was 73.13%, 80.03% and 81.17% respectively. The sensitivity of Myo, cTnI and CK-MB were 100% The specificity was 87.24%, 90.19% and 95.34% respectively. The specificity was significantly improved when cTnI + Myo + CK-MB2 or 3 combined AMI patients. The levels of CK-MB, Myo and cTnI in grade Ⅰ ~ Ⅳ HF patients were significantly different (P <0.05). Conclusion The combined detection of Myo, cTnI and CK-MB has good sensitivity and specificity in the early diagnosis of myocardial infarction and AMI. CTnI and Myo can be used to predict the risk of myocardial infarction.