急性心肌梗死心肌蛋白检测的临床评价

目的探讨心肌损伤标志物心肌蛋白检测在急性心肌梗死(AcuteMyocardialInfarction,AMI)诊断时的应用价值,减少急性心肌梗死漏诊、误诊发生率。方法测定35例AMI病人在发病的第4小时、8小时、24小时,5天等四个时间段的血清肌钙蛋白(IcTnI)、肌钙蛋白T(cTnT)及肌红蛋白(Mb)浓度,和对照组30例健康者体检时的血清相应项目数据对比并进行统计学处理。结果AMI患者发病后4￣8小时血清cTnI、cTnT开始上升,24小时达到峰值,5天仍维持在较高水平,其浓度以及阳性率与正常对照组比较均有显著性差异(P<0.05);而血清Mb在4￣8小时上升幅度更大,但24小时后浓度以及阳性率与正常对照组比较差异不显著(P>0.05)。结论在心肌梗死的早期诊断指标中,Mb的优势明显;cTnI、TnT可用于AMI的早期诊断,但更适用于那些因就诊时间较晚、心肌酶已正常的心梗病人。三者联测可更早、更可靠地提高心肌梗死诊断的准确率。

Clinical evaluation for myocardial protein detection of acute myocardial infarction

Objective To discuss the application value of the detection of the indicative substance of myocardial damage-myocardial protein in the diagnosis of AMI, so as to reduce the percentage of missed diagnosis and misdiagnosis of AMI. Methods To determine the concentrations of cTnI, cTnT and Mb in 35 cases of AMI patients four times: 4 h, 8h, 24h and 5d after the attack of the disease, and compare with the corresponding control group, 30 cases of healthy persons. Results Serum cTnI and cTnT begin to rise 4~8 h after the attack of disease of AMI patients and reach peak value after 24h, and were still in high levels after 5d. Their concentrations and positive rates all had significant difference in comparison with those of the control group (P<0.05); The increase of serum Mb was even obvious 4~8 h after the attack of disease of AMI patients, but the differences of concentration and positive rate after 24 h were not significant in comparison with those of control group (P>0.05). Conclusion Among the parameters of the early stage diagnosis of MI, Mb had obviously advantages. Though cTnI and cTnT can be used for the early stage diagnosis, they were more suitable for the AMI patients whose myocardial enzymes had already reached normal level due to coming late to hospital. The combined detection method of Mb, cTnI and cTnT could increase the accuracy of AMI diagnosis and got a reliable result earlier.