和肽素对急性心肌梗死早期的诊断价值

目的探讨和肽素及肌钙蛋白I（cTnI）对急性心肌梗死的早期诊断价值。方法入选136例因胸闷或胸痛就诊、发病在6h以内且疑诊冠心病的患者,入院即刻抽取静脉血检测和肽素（copeptin）及cTnI,诊断性能用ROC曲线及AUC表示,并根据copeptin、cTnI的阳性率,计算出对急性心肌梗死诊断的灵敏度、特异度等。结果 1AMI组患者血浆copeptin水平及cTnI阳性率显著高于其它三组,差异均有统计学意义（P〈0.05）;2根据ROC曲线分析,和肽素及cTnI的AUC分别为0.821、0.698;95%可信区间分别为0.753-0.889、0.576-0.820。3copeptin分界值为10.75pmol/l时灵敏度为83.3%,特异度为70.8%,阳性预测值为43.6%,阴性预测值为92.6%。本研究所用cTnI试剂盒以0.05ng/mL为分界值,其灵敏度为43.3%,特异度为96.2%,阳性预测值为76.5%,阴性预测值为85.7%。4较单独使用某一指标,联合检测可提高诊断AMI的敏感性（96.7%vs 83.3%vs 43.3%,P〈0.05）。Copeptin〈10.75pmol/L联合cTnI〈0.05ng/mL对于早期排除AMI价值较大,其阴性预测值达98.9%。结论和肽素及cTnI对AMI的早期诊断性能优于单一检测cTnI。对于急诊胸痛患者,联合检测copeptin及cTnI有助于快速排除急性心梗。

Value of copeptin and cTnI in early diagnosis of acute myocardial infarction

Objective To assess the value of copeptin and cTnI for rule out of acute myocardial infarction（AMI）.Methods One hundred and thirty-six patients presenting into emergency departments with chest chocking or chest pain within 6hours were enrolled.copeptin and cTnI was measured.The diagnosis was adjudicated by 2independent experts using all available data.The blood samples were tested for copeptin and cTnI at the same time.The diagnostic performance of them was assessed using ROC analysis.The sensitivity and specificity were inferred based on the positive rate of two cardiac markers.Results 1The levels of copeptin and cTnI in AMI patients were obviously higher than other groups（P〈0.05）;2The AUCs of copeptin and cTnI were 0.821,0.698;and the 95%CI of two markers were 0.753-0.889、0.576-0.8203 Using10.75pmol/L as cut off value,the sensitivity and specificity of copeptin were 83.3%and70.8%,the positive predictive value and negative predictive value were 43.6% and 92.6%to diagnose AMI.Using0.05ng/mL as cut off value,the sensitivity and specificity of cTnI were 43.3%and 96.2%,the positive predictive value and negative predictive value were 76.5%and 85.7% to diagnose AMI.4A copeptin level≥10.75pmol/L pmol/L in combination with cTnI detected AMI with higher sensitivity than for copeptin or cTnI alone（96.7% vs 83.3% vs43.3%,P〈0.05）.The negative predictive value of the combination copeptin＋cTnI was increased,compared to that of cTnI alone（98.9% vs 85.7%,P〈0.05）.Conclusion Determination of copeptin in addition to troponin can improves diagnostic performance,especially early after chest pain onset.They can provides a remarkable negative predictive value and allow a rapid and reliable rule out of the diagnosis of AMI.