入院后6h联合检测心肌生化标志物对可疑急性冠状动脉综合征患者的诊断及预后价值

目的探讨联合检测血清肌红蛋白(Mb)、肌酸磷酸激酶同工酶MB质量(CK-MBm)及肌钙蛋白I(cTnI),在可疑急性冠状动脉综合征(ACS)患者入院后6h内排除和确诊急性心肌梗死(AMI)以及预测不良心血管事件的价值。方法非选择地连续筛查了本院急诊及住院376例怀疑ACS的患者,根据入选标准及排除标准选择研究对象。在患者入院即刻,6、24h采集血标本,连续监测Mb、CK-MBm、cTnI,同时进行心电图ST段监测。结果入选的261例非ST段抬高的患者中,在入院即刻,Mb独立确诊非ST段抬高AMI的灵敏度达到63%,如Mb与CK-MBm联合为79%,Mb与cTnI联合为67%。在入院后6h,确诊非ST段抬高AMI的累积灵敏度Mb为86%,cTnI为88%,CK-MBm为86%,如Mb与CK-MBm联合达96%,Mb与cTnI联合达91%。入院后6h,Mb与CK-MBm联合排除AMI阴性预测值可以高达98%。从入院第2天起至出院前,入院6hcTnI、Mb独立预测发生主要不良心血管事件累计的相对危险比分别是30.0和4.3;预测院内严重不良心血管事件的灵敏度分别为88%,63%。结论对于绝大多数可疑ACS患者,入院后6h联合检测心肌生化标志物即可确诊或排除AMI,与Mb相比,cTnI对于患者心血管事件的危险分层具有更高的价值。

Diagnostic and prognostic role of cardiac biochemical markers in patients with suspected acute coronary syndrome within 6 hours of hospital admission

Objective To determine the concentrations of myoglobin （Mb）, MB isoenzyme of creatine kinase mass （CK-MBm） and troponin I （cTnI） and to explore the diagnostic and prognostic role of these markers in patients with suspected acute coronaw syndrome（ACS） within 6 hours after hospital admission. Methods According to the inclusion and exclusion criteria, 376 unselected and consecutive patients with suspected ACS were chosen as the final study population in the emergency room and cardiovascular department. The blood samples for the measurement of Mb, CK-MBm and cTnI concentrations were taken at 0, 6 and 24 h after hospital admission. All patients received ECG monitoring of ST segment. Results The final study population included 261 patients with non-ST segment elevation ECG. Among them, the sensitivity for diagnosing acute myocardial infarction （AMI） on admission was 63% for Mb alone, 79% for a combination of Mb and CK-MBm, and 67% for a combination of Mb and cTnl. The cumulative sensitivity for diagnosis of non-ST elevation AMI at 6 hours later was 86% for Mb, 86% for CK-MBm, 88% for cTnl, 96% for a combination of Mb and CK-MBm, and 91% for a combination of Mb and cTnI. Major adverse cardiac events from day 2 to discharge were independently predicted by the cumulative 6-hour values of cTnI and Mb with relative risk ratios being 30.0 and 4.3, sensitivity being 88% and 63%, respectively. Conclusion For the vast majority of patients with suspected ACS after 6 hours of hospital admission, AMI can be colffirmed or ruled out by combined detection of cardiac biochemical markers. Compared with Mb, cTnl seemed to be highly valuable in risk stratification of adverse in-hospital cardiac events for patients with ACS.