三种心肌损伤标志物对急性心肌梗死的诊断效率评价

目的 探讨心肌钙蛋白Ⅰ（cTnⅠ）、肌红蛋白（Myo）、肌酸激酶同工酶（CK-MB）单项和联合检测诊断急性心肌梗死（AMI）的敏感性和特异性。方法 分别采取患者发病后2、4、8小时静脉血，采用美国BECKMAN公司180SE ACCESS微粒子全自动化学发光分析仪及配套试剂，24h全天候开机，在1h内完成3项指标的检测。结果 在发病后2小时，只有Myo的敏感性达到45．36％。发病后4小时，Myo、cTnⅠ和CK-MB敏感性分别为89．81％、48．46％和53．92％。cTnⅠ＋Myo和cTnⅠ＋CK-MB的特异性分别为83．89％和85．27％。发病后8小时，cTnⅠ、Myo和CK-MB敏感性均达到100．00％，特异性从高到低依次为cTnⅠ＋Myo＋CK-MB（100．00％）〉cTnⅠ＋CK-MB〉cTnⅠ＋Myo〉Myo＋CK-MB〉cTnⅠ〉CK-MB〉Myo（76．35％）。结论 cTnⅠ、Myo、CK-MB单项和多项联合检测能很好地诊断AMI，但不同时间段各项指标的敏感性和特异性差别较大，临床应连续采血检测才能提高诊断率和制定最佳治疗方案。

Efficiency of three kinds of myocardial injury markers in AMI diagnosis

Objective To investigate sensitivity and specificity of detection of cTnI,Myo,and CK-MB in diagnosing acute myocardial infarction separately and in combination.Methods The venous blood samples from AMI patients were collected at different time-points(2,4,8 h) after heart attack.Three indexes(cTnI,Myo,and CK-MB) detection was completed within one hour by means of a microsome full automatic chemiluminescence analyzer(180SE Access of American Beckman Company) and its relevant reagents.The analyzer kept on working for a whole day.Results At 2 h after attack,only the sensitivity of Myo reached 45.36%.At 4 h after attack the sensitivity of Myo,cTnI and CK-MB reached 89.81%,48.46% and 53.92% respectively.The specificity of cTnI + Myo and cTnI + CK-MB was 83.89% and 85.27% respectively.At 8 h after attack,the sensitivity of cTnI,Myo and CK-MB all reached 100.00%,and the specificity in turn from high to low was cTnI + Myo + CK-MB(100.00%)>cTnI + CK-MB>cTnI + Myo>Myo + CK-MB>cTnI>CK-MB>Myo(76.35%).Conclusion AMI can be diagnosed effectively by both separated and combined examination with cTnI,Myo,and CK-MB,but there is a significant difference of sensitivity and specificity in each index during different period of one hour,so only continuous blood-taking and examination can raise clinical diagnostic rate and establish a best therapeutic strategy.