超敏心肌肌钙蛋白T在急性冠状动脉综合征诊断中的应用

目的评价超敏心肌肌钙蛋白T（hs．cTnT）在急性冠状动脉综合征（ACS）诊断中的临床应用价值。方法收集在急诊科就诊的表现为胸部不适或呼吸短促等疑似ACS患者入院即刻（0h）及住院后4h、12h、20h的血清标本，对不同时间段标本进行hs．cTnT、传统心肌肌钙蛋白T（con．cTnT）、肌红蛋白（MYO）、肌酸激酶同工酶（CK．MB）浓度检测，比较各检测指标在疑似ACS和确诊急性心肌梗死（AMI）患者中的阳性检出率。结果在559例疑似ACS患者中，4种心肌标志物在0h检测时，hs—cTnT阳性率与con—cTnT、MYO、CK．MB阳性率比较差异有统计学意义（x。值分别为189．262、210．563和146．282，P〈0．05）；在79例AMI患者中，4种心肌标志物在0h、4h、12h、20h的不同时间点的阳性率也有较大差异，在入院0h时hs．cTnT检出阳性率与con．cTnT、MYO、CK．MB的阳性率比较差异有统计学意义（xz值分别为20．721、29．187和16．892，P〈0．05）；在入院4h时hs．cTnT阳性率与con．cTnT、MYO、CK—MB的阳性率比较差异有统计学意义（x：值分别为6．452、28．299、21．597，P〈0．05）；在人院12h时hs．cTnT阳性率与COll．cTnT、CK．MB阳性率差异无统计学意义（x2值分别为1．006和4．104，P〉0．05），但与MYO的阳性率差异有统计学意义（x。值为41．712，P〈0．05）；在人院20h时hs．cTnT阳性率与con．cTnT阳性率差异无统计学意义（x。值为3．058，P〉O．05），但与MYO、CK．MB的阳性率比较差异有统计学意义（x2值为102．042和19．050，P〈0．05）。结论hs．cTnT是一种敏感的心肌损伤早期诊断生物标志物，相比较con-cTnT、MYO、CK．MB能够为AMI的早期诊断提供可靠依据，是疑似ACS患者发生不良事件很好的预测指标。

Clinical Application of the High-Sensitivity Cardiac Troponin T Assay in Acute Coronary Syndrome

Objective To evaluate the clinical application of high-sensitivity cardiac troponin T （hs-cTnT） in diagnosis of acute coronary syndrome （ACS）. Methods The related biological markers including hs-cTnT,conventional cardiac troponin T （con-cTnT）, myoglobin （MYO）, creatine kinaseisoenzyme MB （CK-MB） were determined for all samples from 559 patients with suspected ACS such as chest discomfort or be short of breath on immediate admission and 4 h, 12 h and 20 h after admission.The positive rates of 4 kinds of myocardial markers of the patients with suspected ACS and who were diagnosed of myocardial infarction were compared. Results Among different makers obtained from 559 cases of patients with suspected ACS on immediate admission, hs-cTnT had the highest detection rate, and were significantly higher than those of con-cTnT, MYO, and CK-MB（Chi-square values of con-cTnT, MYO and CK-MB were 189.262, 210.563 and 146.282, respectively,P〈O.05）. The detectable rates of hs-cTnT, con-cTnT, MYO and CK-MB from 79 acute myocardial infarction（AMI） patients on immediate admission showed significant differences at 0 h, 4 h, 12 h and 20 h after admission. At Oh the positive rate of hs-cTnT was significantly different from those of con-cTnT, MYO and CK- MB （Chi-square values of con-cTnT, MYO and CK-MB were 20.721,29.187 and 16.892, respectively, all P〈0.05） ; after admission of 4 h, hs-cTnT positive rate had significant differences with the others （Chi-square values of con-cTnT, MYO and CK-MB were 6.452,28.299 and 21.597,respectively,all P〈0.05＇）; after admission of 12 h,hs-cTnT positive rate was not statistically significant different from those of con-cTnT and CK-MB （Chi-square values of con-cTnT and CK-MB were 1.006 and 4.104, respectively,all P〉0.05）, but was significantly different from that of MYO （Chi-square value of MYO was 41.712, respectively,P〈0.05） ; after admission of 20 h hs-cTnT positive rate had significant differences with the those of M~O and CK-MB （Chi-square values of MYO and CK-MB were 102.042 and 19.050, respectively, all P〈 0.05 ）, but had no significant difference from that of con-cTnT （Chi-square values of con-cTnT was 3.058,respectively, /〉〉0.05）. Conclusion High-sensitivity cardiac troponin T（hs-cTnT） is a sensitive myocardial damage biomarker for early diagnosis,Compared to con-cTnT,MYO,and CK-MB,it gives a reliable basis for an earlier detection of myocardial infarction, and can be used to predict adverse outcomes in patients with suspected ACS.