急性心肌梗死实验室诊断分析

目的探讨肌红蛋白（Mb）、肌钙蛋白T（cTnT）、肌酸激酶同工酶（CK-MB）对急性心肌梗死的诊断应用价值。方法肌红蛋白用免疫比浊法测定;cTnT用BECKMAN Access2化学发光仪测定;CK-MB用贝克曼LX-20全自动生化分析仪测定;然后进行统计学分析。结果 Mb诊断灵敏度在8h达到最高为85%,cTnT灵敏度在24h达99.5%,显著高于Mb的灵敏度,但与CK-MB无明显差异。特异性最高的是CK-MB,在4、8、12、24h的四个时间段平均特异性为98.5%,但与Mb相比差异无统计学意义（P〉0.05）,在各个四个时点Mb阳性预测值明显高于cTnT的阳性预测值（P〈0.01）,但与CK-MB的阳性预测值无明显的差别（P〉0.05）,阴性预测值在4h Mb高于cTnT和CK-MB。结论检测Mb、cTnT、CK-MB的准确性、灵敏度可靠,对急性心肌梗死的早期诊断有重要价值。

Value of detection of myohemoglobin(Mb),troponinT(cTnT)and creatine kinase mb(CK-MB)in diagnosis of acute myocardial infarction

Aim To explore the applied value of detection of myohemoglobin（Mb）,cardiac troponin T（cTnT）and creatine kinase MB（CK-MB）for the diagnosis of acute myocardial infarction（AMI）.Methods Myohemoglobin was detected by immunoturbidimetry（ITM）;cTnT was detected by BECKMAN Access2 chemiluminescence apparatus and CK-MB was detected by BECKMAN LX-20 automatic biochemical analyzer.Results The sensitivity of Mb was as high as 85%in eight hours,and that of cTnT was 99.5%in 24 hours,significantly higher than that of Mb detection but not obviously different from that of CK-MB.The highest specificity was detection of CK-MB with an average specificity of 98.5%in 4,8,12 and 24 hours,without statistical difference（P0.05）compared with megabytes（Mb）.The positive predictive value （PPV）of Mb at the four timepoints was obviously higher than that of cTnT（P0.01）,but the positive predictive value of CK-MB was not significandy difference（P0.05）.The negative predictive value of Mb was higher than that of cTnT and CK-MB at the timepoint of 4-hour.Conclusion The accuarcy and sensitivity of detecting Mb,cTnT and CK-MB were reliable and valuable for the early diagnosis of acute myocardial infarction（AMI）.