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目的:探讨心肌肌钙蛋白(cTn)诊断和除外急性心肌梗死(AMI)的界限值。方法:因心血管疾病住院及尿毒症透析患者共334例,分为AMI组30例、心绞痛组90例、心力衰竭组56例、心律失常组41例、高血压组97例、尿毒症组20例。入院次日清晨空腹抽取血标本,同时测量cTnI、cTnT及肌酸激酶同工酶(CK-MB)。分析比较cTnI、cTnT及CK-MB达到正常参考人群数值的第95百分位数及2倍于此数值时对于诊断AMI的敏感性、特异性及准确性。结果:AMI组与其他各组相比,cTn和CK-MB增高差异有统计学意义(P<0.05);除AMI组外其他组患者cTnI、cTnT和CK-MB测定值均有部分高于正常参考人群数值的第95百分位数,且与AMI组有重叠。结论:cTnI和cTnT达到正常参考人群数值的第95百分位数时对AMI诊断的敏感性无明显差异,特异性cTnT高于cTnI。CK-MB的敏感性不高但是特异性很高,与cTnT类似,仍可做AMI排除诊断用。建议心肌标志物应该有2个界限值,一个是目前的正常参考人群数值的第95百分位数,为诊断AMI的界限值;另一个是2倍于此数值,用于排除非缺血性心肌损伤。
Objective: To investigate the value of cardiac troponin (cTn) diagnosis and exclusion of acute myocardial infarction (AMI). Methods: A total of 334 hospitalized patients with cardiovascular disease and uremic dialysis were divided into AMI group 30 cases, angina pectoris group 90 cases, heart failure group 56 cases, arrhythmia group 41 cases, hypertension group 97 cases, uremia group 20 example. Fasting blood samples were taken on the morning of the next hospital admission, meanwhile cTnI, cTnT and creatine kinase isoenzyme (CK-MB) were measured. To analyze the sensitivity, specificity and accuracy of cTnI, cTnT and CK-MB in reaching the 95th percentile of normal reference population and 2 times of this value in diagnosing AMI. Results: Compared with other groups, the difference of cTn and CK-MB in AMI group was statistically significant (P <0.05). The values of cTnI, cTnT and CK-MB in other groups except AMI group were higher than normal The 95th percentile of the reference population value overlaps with the AMI group. CONCLUSIONS: There is no significant difference in the sensitivity of AMI for cTnI and cTnT when reaching the 95th percentile of normal reference population, and the specific cTnT is higher than cTnI. The sensitivity of CK-MB is not high but high specificity, similar to cTnT, it can still be used to diagnose AMI. It is recommended that myocardial markers should have 2 thresholds, one is the 95th percentile of the current normal reference population, the threshold for the diagnosis of AMI, and the other is 2 times this value for excluding non-ischemic Myocardial injury.