心肌标志物合理检测对急性心肌梗死的诊断

目的对肌酸激酶及其同工酶(CK、CK-MB)和心肌肌钙蛋白T(cTnT)进行比较,为急性心肌梗死(AMI)的早期诊断和不良预后评估提供较合理的检测指标。方法对123例高度可疑的AMI患者在入院后24h内检测CK、CK-MB活性和cTnT,比较它们对AMI诊断的敏感性和特异性,并进行优化组合。结果(1)在入院后24h内CK、CK-MB活性和cTnT对AMI的敏感性分别为89.3%、77.7%和94.2%,特异性分别为80%、100%和100%;(2)AMI患者随着cTnT水平的升高短期(1个月)死亡率显著增加(P<0.01),从4.3%(cTnT≤0.4ng/ml)、15.4%(0.4~1.0ng/ml)到30.2%(≥1.0ng/ml)。(3)CK与cTnT联合检测对AMI的敏感性为97.1%,特异性为80%;(4)CK-MB活性出现阳性时,cTnT均阳性,而且同一标本cTnT升高程度显著高于CK-MB(P<0.05)。结论CK与cTnT联合检测对诊断AMI具有高度的敏感性和特异性,在此基础上再检测CK-MB活性不会增加其敏感性和特异性。     

血清CK-MB、cTnT及MMP-9对急性心肌梗死诊断的应用价值

目的探讨血清肌酸激酶同工酶(CK-MB)、心肌钙蛋白(cTnT)及基质金属蛋白酶-9(MMP-9)对急性心肌梗死(AMI)诊断的应用价值。方法选取100例AMI患者(AMI组)、100例不稳定型心绞痛患者(UAP组)以及100例健康体检者(对照组)为研究对象。检测三组受试人员血清CK-MB、cTnT及MMP-9水平,采用受试者工作曲线(ROC)分析三项指标在AMI诊断中的价值,探讨AMI患者血清CK-MB、cTnT及MMP-9之间的相关性。结果 AMI组患者血清CK-MB、cTnT及MMP-9水平明显高于UAP组和对照组,而UAP组患者血清CK-MB、cTnT及MMP-9水平又明显高于对照组,差异均具有统计学意义(P0.05)。AMI患者血清CK-MB、cTnT及MMP-9水平随着病变血管支数增加而明显提高,差异有统计学意义(P0.05)。根据ROC曲线分析可得CK-MB、cTnT及MMP-9诊断AMI的最佳临界值为CK-MB30.56U/L、cTnT0.46μg/L、MMP-9213.27ng/L,其ROC曲线下面积分别为0.873、0.890、0.877,诊断敏感性分别为64.0%、74.0%、85.0%,特异性分别为90.0%、88.5%、74.0%。三项指标联合检测敏感性明显高于单独检测,差异具有统计学意义(P0.05)。AMI组患者血清CK-MB、cTnT及MMP-9之间呈正相关性(P0.05)。结论AMI患者血清CK-MB、cTnT及MMP-9呈高表达,其水平与患者病情密切相关,联合检测血清CK-MB、cTnT及MMP-9水平有助于AMI的早期诊断和治疗。     

16例急性心肌梗死患者肌钙蛋白T的临床分析

目的：探讨肌钙蛋白T(cTnT)在急性心肌梗死(AMI)早期诊断中的作用。方法：前瞻性对比分析16例AMI患者与35例非AMI的cTnT与肌酸激酶同工酶(CK-MB)的变化。结果：cTnT在AMI患者的血中出现较早。与CK-MB比较，其对AMI的敏感性高、特异性强。结论：cTnT检测是较理想的早期诊断AMI方法之一，特别在基层医院。     

肌钙蛋白T、肌红蛋白、肌酸激酶及其同工酶联合测定的临床意义

目的探讨联合肌钙蛋白T(cTnT)、肌红蛋白(Mb)、肌酸激酶(CK)及其同工酶(CK-MB)测定在诊断急性心肌梗死(AMI)中的临床意义。方法对急性AMI患者在不同时间抽血检测cTnT、Mb、CK、CK-MB,计算其阳性率,对照组也分别检测以上项目。结果在6h检测时的阳性率最高为Mb(93.3%),因其受影响的因素较多,骨骼肌损伤时Mb和CK的阳性率也较高,肠癌时CK-MB的阳性可能是假阳性。cTnT的特异性最高,Mb和CK的特异性较差,所以只有几个项目联合检测时确诊率才是最高。结论因cTnT、Mb、CK、CK-MB均受很多因素的影响,具有一定的局限性,只有进行联合检测才能提高急性AMI确诊的速度和确诊率。     

肌钙蛋白T在急性心肌梗死中的诊断意义

目的:探讨血清肌钙蛋白T(cTnT)的动态变化对急性心肌梗死(AMI)的诊断意义。方法:对60例AMI患者进行动态观察血清cTnT变化,同时测定肌酸激酶同工酶(CK-MB)进行对比。结果:AMI患者胸痛4h内cTnT阳性率高于CK-MB(P<0.05),12～24h两者无显著差异(P>0.05),48h后两者存在显著差异(P<0.01)。结论:cTnT定性检测对AMI诊断具有早期、特异性高、时间窗长的特点,是诊断AMI较理想的方法之一。     

心型脂肪酸结合蛋白在急性心肌梗死早期诊断中的意义

目的探讨血清心型脂肪酸结合蛋白(HFABP)在急性心肌梗死(AMI)患者早期诊断中的意义。方法采用双抗夹心酶联免疫法测定146例临床疑似AMI患者发病后不同时间血清HFABP的浓度,并与血清肌酸激酶同工酶B(CK-MB)、心肌肌钙蛋白I(cTnI)水平进行比较。结果 AMI患者发病早期入院时、发病2 h、入院后6～8 h检测血清HFABP、CK-MB和cTnI浓度明显高于非AMI组和对照组(P<0.001)。在AMI发病早期,HFABP指标的敏感性、特异性、准确性、阳性率预测值和阴性率预测值分别为83.3%、94.0%、88.5%、93.8%、83.9%,均明显高于CK-MB和cTnI。结论在AMI发病早期,HFABP具有敏感性、特异性和准确性高等优势,可作为AMI早期诊断的重要生化指标。     

血清心肌型脂肪酸结合蛋白检测在急性心肌梗死诊断中的应用

目的探讨血清心肌型脂肪酸结合蛋白（H-FABP）在急性心肌梗死（AMI）诊断中的应用价值。方法选择95例疑似急性心肌梗死的胸痛患者,用快速检测试剂盒检测患者发病0～3、3～6h和6h后血清的H-FABP,并和心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）的检测结果进行比较,分析3种心肌标志物在AMI不同发病时间段诊断中的敏感性和特异性。结果 3种指标在所有胸痛患者中检出率差异无统计学意义（P〉0.05）,但在AMI组患者中,H-FABP的阳性率为72.9%,显著高于cTnI（66.7%）及CK-MB（62.5%）,差异有统计学意义（P〈0.05）。H-FABP检测诊断AMI的敏感性在0～3h（70.00%）和3～6h（82.61%）时间段显著高于cTnT（20.00%与65.22%）和CK-MB（10.00%与65.22%）;在诊断特异性上,H-FABP高于CK-MB,但比cTnI低。结论 H-FABP对于诊断早期AMI具有较高的敏感性和良好的特异性,适合于临床AMI的早期诊断。     

两种方法快速检测cTnT诊断急性心肌梗死的临床对比研究

目的对比观察免疫层析法和化学发光免疫分析法快速检测心肌肌钙蛋白T(cTnT)在急性心肌梗死(AMI)诊断中的临床意义。方法选取AMI患者300例,随机分为A组150例和B组150例,并再选取同期收治的健康体检的83人为对照组,分别采用快速免疫层析法和化学发光免疫分析法检测三组cTnT,同时检测三组肌酸激酶同工酶MB(CK-MB)。比较并分析三组的检测结果。结果化学发光免疫分析法检测cTnT阳性率高于快速免疫层析法,差异有统计学意义(P0.05);AMI患者cTnT的表达阳性率明显高于CK-MB,差异均具有统计学意义(P0.05);不同浓度范围,cTnT的敏感性均高于CK-MB(P0.05)。结论 cTnT在AMI的诊断中具有较高敏感性,且化学发光免疫分析法在cTnT测定中操作简单,所需时间较短,值得临床推广使用。     

心肌损伤标志物在急性冠状动脉综合征中的诊断价值

目的评价心肌肌钙蛋白T(cTnT)、肌红蛋白(Myo)、与肌酸激酶同工酶(CK-MB)在急性冠状动脉综合征(ACS)中的诊断价值。方法将ACS患者分为不稳定心绞痛组(UAP组)和急性心肌梗死组(AMI组),抽取静脉血,在Elecsys 2010分析仪上测定cTnT、Myo、CK-MB含量。结果 UAP组cTnT、Myo、CK-MB的阳性率分别为42.4%、28.0%、13.0%;AMI组cT-nT、Myo、CK-MB的阳性率分别为87.9%、79.2%、43.0%。结论 cTnT是反映心肌组织损伤的高敏感度、高特异度的生化检测标志物,在ACS的早期诊断中具有重要价值。     

心肌损伤标志物在急性冠状动脉综合征中的诊断价值

目的评价肌红蛋白(Myo)、心肌肌钙蛋白T(cTnT)与肌酸激酶同工酶(CK-MBmass)在急性冠状动脉综合征(ACS)中的诊断价值。方法将ACS患者分为不稳定型心绞痛(UAP)组和急性心肌梗塞(AMI)组,抽取静脉血,在Elecsys2010分析仪上测定Myo、cTnT、CK-MB mass含量。结果UAP组Myo、cTnT、CK-MB mass的阳性率分别为24.0%、39.6%、11.0%;AMI组的阳性率分别为77.8%、86.7%、42.0%。结论cTnT是反映心肌组织损伤的高度敏感特异的生化检测标志物,在ACS的早期诊断中具有重要价值。     

cTnT、CK-MB、FIB和DD联合检测在急性心肌梗死中的诊断价值

目的 通过对肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)、纤维蛋白原(FIB)和D-二聚体(DD)联合检测为急性心肌梗死(AMI)患者的诊断和治疗提供依据.方法 临床及冠脉造影明确诊断的AMI患者67例为病例组,30例体检健康者为对照组,应用化学发光法、凝固法分别检测cTnT、CK-MB、FIB和DD等.结果 病例组CK-MB、cTnT、FIB、DD分别为(7.325±4.054)ng/mL、(12.201±8.235)ng/mL、(483.70±153.44)mg/dL、(725±363)μg/L;对照组CK-MB、cTnT、FIB、DD分别为(3.272±1.227)ng/mL、(0.045±0.042)ng/mL、(281.02±56.32)mg/dL、(426±151)μg/L;CK-MB、cTnT分别检测,CK-MB+cTnT联合检测,及4项指标联合检测的阳性率分别为58.2%、68.7%、77.6%、91.1%;病例组与对照组CK-MB、cTnT、FIB、DD含量比较差异有统计学意义(P<0.01).结论 CK-MB、cTnT、FIB、DD联合检测对AMI患者的早期诊断具有重要意义.     

Single-point cardiac troponin T at coronary care unit discharge after myocardial infarction correlates with infarct size and ejection fraction

BACKGROUND: One of the major concerns in replacing creatine kinase MB (CK-MB) with cardiac troponins is the lack of evidence of the ability of troponins to estimate the size of acute myocardial infarction (AMI). We investigated the ability of a single measurement of cardiac troponin T (cTnT) at coronary care unit (CCU) discharge to estimate infarct size and assess left ventricular (LV) function in AMI patients. METHODS: We studied 65 AMI patients in whom infarct size was estimated by CK-MB peak concentrations and gated single-photon emission computed tomography (SPECT) myocardial perfusion using technetium-99m sestamibi and LV function by SPECT imaging. Measurements of cTnT and SPECT were performed 72 h (median) after admission (range, 40-160 h). SPECT was also repeated 3 months later. RESULTS: We found a significant correlation between cTnT and both the peak CK-MB concentrations (r = 0.76; P <0.001) and the perfusion defect size at SPECT (r = 0.62; P <0.001). cTnT was inversely related to LV ejection fraction (LVEF) assessed both early (r = -0.56; P <0.001) and 3 months after AMI (r = -0.70; P <0.001). cTnT >2.98 micro g/L predicted a LVEF <40% at 3 months with a sensitivity of 86.7%, specificity of 81.4%, and a likelihood ratio for a positive test of 4.7 (95% confidence interval, 4.0-5.4). CONCLUSIONS: A single cTnT measurement at CCU discharge after AMI is useful as a noninvasive estimate of infarct size and for the assessment of LV function in routine clinical setting.     

探讨白细胞介素-6、肿瘤坏死因子-α等血清炎性因子在急性心梗中的应用价值

目的 探讨急性心肌梗死（acute myocardial infarction,AMI）患者血清中白细胞介素-6（interleukin,IL-6）、肿瘤坏死因子-α （tumor necrosis factor-α,TNF-α）、超敏C反应蛋白（high sensitive C-reactive protein,hs-CRP）的水平变化及其临床意义.方法 收集我院2012年10月至2013年10月,门急送检并经冠状动脉造影确诊为AMI的患者83例,根据心肌肌钙蛋白T（cardiac troponin T,cTnT）水平分为cTnT弱阳性组28例,cTnT阳性组55例,同期收集健康体检者30例为健康对照组.检测所有受试者血清IL-6、TNF-α、hs-CRP水平,测定结果与心肌酶谱中敏感性最高的肌酸激酶同工酶（creatine kinase-MB,CK-MB）相比较,并对检测结果进行统计学分析.结果 三组间CK-MB、IL-6、TNF-α、hs-CRP检测结果比较差异均具有统计学意义（P均＜0.05）.cTnT阳性组患者血清CK-MB、IL-6、TNF-α、hs-CRP水平均明显高于健康对照组,且差异均具有统计学意义（P均＜0.05）.cTnT弱阳性患者组血清IL-6、TNF-α、hs-CRP水平均显著高于健康对照组及cTnT阳性组,差异均有统计学意义（P均＜0.05）.CK-MB水平在cTnT阳性组与弱阳性组之间差异无统计学意义（P＞0.05）.cTnT弱阳性患者组中IL-6、TNF-α、hs-CRP异常率明显高于cTnT阳性组,且差异均有统计学意义（P均＜0.05）.cTnT阳性患者组中CK-MB异常率与cTnT弱阳性组差异无统计学意义（P＞ 0.05）.多因素Logistic回归分析显示,IL-6、TNF-α、hs-CRP均是AMI的独立危险因素（P均＜0.05）.结论 IL-6、TNF-α、hs-CRP等炎性指标与AMI发生、发展相关,与cTnT联合检测对AMI早期诊断具有较好的临床应用价值.     

Evaluation of a Bedside Whole-blood Rapid Troponin T Assay in the Emergency Department

Objective : To evaluate the performance of a new bedside whole-blood rapid assay for cardiac troponin T (cTnT) in patients presenting to the ED with symptoms consistent with acute coronary ischemia. Methods : A prospective, observational trial was performed in 8 participating medical centers. Serial blood samples were obtained on presentation to the ED and 3 and 6 hours later. The cTnT whole-blood rapid assays were performed immediately at the site. Treating physicians and patients were blinded to the results of the rapid assays. Serum samples were analyzed at the core laboratory for serum cTnT, creatine kinase (CK)-MB, and myoglobin. The sensitivity of the rapid assay for detecting acute myocardial infarction (AMI) was compared with the sensitivities of serum cTnT, CK-MB, and myoglobin assays. Results : Of 721 patients, 102 were diagnosed as having AMI. The median elapsed time from symptom onset to ED arrival was 3 hours. The sensitivities of the rapid assay for detecting AMI were 19.6%, 59.0%, and 69.7% at 0, 3, and 6 hours, respectively. The sensitivities of the serum cTnT assay (p-values for comparison with the rapid assay for cTnT) were 25.0% (p = 0.18), 69.6% (p = 0.04), and 79.8% (p = 0.02) at 0, 3, and 6 hours, respectively. The CK-MB and myoglobin sensitivities were 21.9%, 64.5%, and 81.0%; and 43.8%, 77.4%, and 71.4%, respectively. There were 7 patients with AMI who had negative rapid assay readings and positive serum cTnT levels; 4 of these patients were enrolled at the same site. Twenty patients not diagnosed as having AMI had at least one positive rapid assay. Fourteen of these 20 patients had a diagnosis of clinically relevant cardiac disease. Conclusions : The sensitivity of this whole-blood rapid cTnT assay for detecting AMI is comparable to that of current serum assays and offers the advantage of providing rapid bedside results. Discrepancies between serum and whole-blood assays for cTnT noted in this study may indicate the need for further education for the test reader prior to patient use.     

肌钙蛋白Ⅰ与CK-MB联合检测对急性心肌梗死的诊断价值

目的探讨肌钙蛋白I(cTnI)与CK-MB联合检测对急性心肌梗死(AM I)的临床诊断价值。方法采用罗氏电发光2010自动生化分析仪和日立7180生化分析仪,测定62例AM I患者、50例健康体检者血清的cTnI、肌酸激酶(CK)和CK-MB,并对结果进行统计学分析。结果AM I组血清cTnI、CK和CK-MB高于正常对照组(P<0.01)。cTnI与CK-MB联合检测阳性率为96.7%,高于前三者,且动态检测对早期AM I敏感性更高、阳性持续时间更长。结论肌钙蛋白I与CK-MB联合检测能提高早期急性心肌梗死的检出率,具有更宽的诊断时间窗。     

心脏型脂肪酸结合蛋白对急性心肌梗死早期诊断的临床价值研究

目的探讨心脏型脂肪酸结合蛋白（H—FABP）在急性心肌梗死（AMI）早期诊断中的临床应用价值。方法将来本院的AMI疑似患者156例,按就诊时发病时间分为2组,分别在发病后0～3、3～6h内同时检测H—FABP、肌钙蛋白T（cTnT）、肌酸激酶同工酶（CK—MB）。计算各项指标的灵敏度、特异性、准确度,并进行比较分析。结果H-FABP在发病0～3h内诊断的灵敏度为70．7％,特异性为97．0％,准确度为82．4％,显著高于cTnT和CK—MB,差异有统计学意义（P〈0．05）。在发病3～6h内诊断的灵敏度为100．0％,显著高于cTnT,差异有统计学意义（P％0．05）,特异性为92．6％,准确度为97．6％。结论H—FABP是AMI早期诊断最敏感的指标,具有非常重要的临床应用价值。     

Time-dependent diagnostic performance of a rapid troponin T version 2 bedside test in patients with acute coronary syndromes

In a prospective trial, the diagnostic performance of the second version of the troponin T rapid assay (Trop T; cutoff 0.2 microg/L) was compared with the quantitative cardiac-specific troponin T assay (cTnT ELISA; cutoff 0.1 microg/L) and other established cardiac markers such as CK, CK-MB activity, CK-MB mass and myoglobin. Additionally, a 30-day follow-up was performed to determine the suitability of the Trop T assay and the reference markers for short-term risk stratification. Two-hundred-and-eighty-six consecutive patients with chest pain and suspected acute myocardial infarction (AMI) were enrolled in two CCU departments. Serial blood specimens were taken at admission and at 3, 6, 12, 24, 48, 72 and 96 h after admission. According to the biochemical criterion CK-MB mass, the patients were classified as having AMI in 154 patients (54%), unstable angina (UAP) in 72 patients (27%) and no evidence for acute cardiac ischemia in 55 patients (19%). Analytical method comparison of Trop T with cTnT ELISA (cutoff 0.1 microg/L) showed a good agreement, Trop T yielded only 4% false-negative and 3% false-positive results. The diagnostic performance of Trop T for the detection of AMI was only slightly inferior compared to cTnT ELISA. Beyond 12 h after admission, Trop T and cTnT ELISA maintained a sensitivity close to 100%, whereas the sensitivity of the other cardiac markers decreased sharply. The diagnostic sensitivity of Trop T for the detection of minor myocardial damage in UAP patients was the same as for cTnT ELISA. Death within 30 days' follow-up occurred only in AMI patients with a positive Trop T test result within the first 6 h after admission. The admission Trop T and cTnT ELISA were the only significant biochemical predictors of major cardiac events. In conclusion, these data show that Trop T has similar diagnostic sensitivity as cTnT ELISA and is a useful tool to confirm acute or subacute myocardial infarction. Trop T is an excellent marker in detecting minor myocardial damage in UAP patients and is suitable for short-term risk stratification.     

心肌钙蛋白T定性在急性冠状动脉综合征诊断上的应用

目的　评价心肌钙蛋白T (cTnT)在急性冠状动脉综合征的诊断价值。方法　收入急诊ICU的急性冠状动脉综合征病人分为 :AMI组和UAP组 ,抽取肘部静脉血 1ml立即注入肝素抗凝试管中 ,混匀。用德国宝灵曼中国有限公司提供的肌钙蛋白T灵敏检测试纸条进行定性检查。同时用放免分析方法测定血清CK、CK MB及AST。结果　AMI组cTnT阳性率为 70 6 % ,UAP组阳性率 16 7% ,两组阳性率对比有显著性差异性 (P <0 0 1)。结论　cTnT是反映心肌细胞损伤的灵敏性、特异性均较好的生化指标 ,cTnT定性检测可用于ACS早期鉴别诊断 ,其临床意义优于血清CK、CK MB及AST。     

心型脂肪酸结合蛋白在早期急性心肌梗死中的诊断价值

目的 探讨心型脂肪酸结合蛋白（H-FABP）在早期急性心肌梗死中的诊断价值.方法 选择我院收治的疑为AMI胸痛患者126例,进行H-FABP、cTnT及CK-MB检测.结果 34例AMI患者发病3h内血液H-FABP检测灵敏度和准确性显著高于cTnT和CK-MB,差异有统计学意义（P＜0.05）;48例AMI患者发病3-6 h血液HFABP检测灵敏度和准确性显著高于cTnT,差异有统计学意义（P＜0.05）,但与CK-MB比较,差异无统计学意义（P＞0.05）.非AMI患者H-FABP在以上两个时间段均为正常值.结论 H-FABP用于早期诊断急性心肌梗死准确性高,值得临床推广.