目的:探讨心肌坏死标志物联合检测在急性心肌梗死(AMI)早期诊断中的应用价值。方法:选择2015年9月至2016年9月在我院确诊的AMI患者65例设为AMI组,以同期30例疑似AMI而最终诊断非AMI的患者作为对照组,所有患者均检测血清中肌钙蛋白I(c Tn I)、肌红蛋白(Mb)及肌酸肌酶同工酶(CKMB),并比较以上标志物的诊断符合率。结果:AMI组患者0~2 h的c Tn I和Mb明显升高,达到AMI的诊断标准,且2~12 h和12~24 h内均维持在较高水平,能诊断AMI;CK-MB早期(0~2 h)并不能诊断AMI,但2~12 h和12~24 h均达到了诊断AMI的诊断标准。以冠脉造影为诊断AMI的金标准,AMI组患者c Tn I、Mb、CK-MB和联合诊断符合率分别为78.5%、80%、69.2%和93.8%,对照组为92.5%、87.5%、80%和100%,两组联合诊断符合率均显著高于单一诊断符合率(P<0.05)。以0~2 h心肌损伤指标水平为标准对AMI进行诊断发现,c Tn I、Mb、CK-MB三者联合的诊断效能较高,明显高于单用c Tn I及c Tn I联合CK-MB进行诊断者,诊断的敏感性、特异性分别高达为94.9%、100%,差异均具有统计学意义(P<0.05)。结论:心肌坏死标志物联合检测有助于AMI的早期诊断,值得临床推广应用。 Objective: To investigate the value of combined detection of myocardial necrosis markers in the early diagnosis of acute myocardial infarction (AMI). Methods: Sixty-five AMI patients diagnosed in our hospital from September 2015 to September 2016 were enrolled as the AMI group. Thirty patients with the suspected AMI and the final diagnosis of non-AMI were selected as the control group. All the patients were tested for serum myo- CTn I, Mb and creatine kinase isoenzyme (CKMB), and the diagnostic coincidence rates of the above markers were compared. Results: The levels of cTn I and Mb in AMI group were significantly increased at 0 ~ 2 h, reaching the diagnostic criteria of AMI. AMI was maintained at a high level in 2 ~ 12 h and 12 ~ 24 h, which could be used to diagnose AMI. CK-MB Early (0 ~ 2 h) can not diagnose AMI, but 2 ~ 12 h and 12 ~ 24 h have reached the diagnosis of AMI diagnostic criteria. Coronary angiography was the gold standard for the diagnosis of AMI. The coincidence rates of cTn I, Mb, CK-MB and combined diagnosis were 78.5%, 80%, 69.2% and 93.8% respectively in the AMI group and 92.5% and 87.5% , 80% and 100% respectively. The coincidence rates of the two groups were significantly higher than those of single diagnosis (P <0.05). The diagnosis of AMI was based on the level of 0 ~ 2 h myocardial injury index, and the diagnostic efficacy of cTn I, Mb and CK-MB combination was significantly higher than that of cTn I and cTn I alone combined with CK- MB diagnosis, the diagnostic sensitivity and specificity were as high as 94.9%, 100%, the difference was statistically significant (P <0.05). Conclusion: The combined detection of myocardial necrosis markers contributes to the early diagnosis of AMI, which is worthy of clinical application.