四种新的心肌损伤标记物在急性心肌梗死早期诊断中的比较研究

目的 :探讨新的生化标记物对急性心肌梗死 (AMI)早期诊断价值。　　方法 :动态监测 98例AMI患者血清肌红蛋白 (Mb) ,心肌肌钙蛋白I、T (cTnI、cTnT )及肌酸激酶MB同工酶(CK MB)的变化 ,对比分析它们对AMI的早期诊断及对预后的判断。　　结果 :AMI起病 6小时之内 ,以Mb诊断敏感性最高 (90 2 0 % ) ,cTnI次之 (5 2 94% ) ,CK MB最低 (2 7 45 % ) ;cTnI和cTnT升高显著且较长时间不降者预后差。　　结论 :早期确诊或排除AMI以cTnI和Mb组合更为可取 ;判断溶栓是否再通以cTnI和CK MB更为准确可靠 ;对那些心肌损伤标记物升高显著 ,且较长时间居高不降者 ,提示预后欠佳。

Comparative Study of New Myocardial Injury Marker in Early Diagnosis of Acute Myocardial Infarction

Objective:This study was designed to evaluate whether a new marker or combined markers are the better choice for patients with early acute myocardial infarction(AMI). Methods:Serial serum concentrations of myoglobin(Mb),cTnI.cTnT,creatine kinase-MB(CK MB)were measured in 98 patients with established AMI.Their diagnostic and prognostic values for AMI were comparatively analyzed. Results:The diagnostic accuracy of Mb,cTnI and CK MB was 90 20%,52 94% and 27 45% respectively within 6 hours after the onset of chest pain.Nine patients,who had higher and longer serum cTnI and cTnT values,died from cardiac shock and sudden death.Other four patients with higher serum cTnI and cTnT died during a follow up period. Conclusion:Combination of myoglobin and cTnI is a better marker for the diagnosis of AMI.cTnI and CK MB are reliable for the prediction of coronary artery reperfusion after thrombolytic therapy.Long lasting and significant high cTnI and cTnT may be the indicators of poor prognosis.