急性心肌梗塞时血清心脏肌钙蛋白Ⅰ的测定及临床意义

测定急性心肌梗塞(AMI)病人血清心脏肌钙蛋白I(cTnI)和心肌酶学水平,以探讨其诊断AMI价值.方法:cTnI和心肌酶学分别以固相免疫法析法和酸法测定.结果:50例AMI病人cTnI阳性率98.00%较高血压病EH]患者(0/21)和正常人(0/43)显著升高(P约<0.0001).31例AMI cTnI高阳性者心肌酶学敏感性83.87%与cTnI近似(P=0.103),而在18例AMI cTnI低阳性者中仅22.22%,较cTnI差异显著(P<0.0001).15例AMI cTnI高阳性者于发病后2天cTnI和心肌酶阳性率较高,7～10天cTnI仍有较高的阳性率(86.67%),但后者显著下降(20.00%)并于10天后恢复正常.cTnI阳性率10d后始明显下降(36.36%),少数持续3周.结论:cTnI诊断AMI具高度特异性和敏感性,对AMI微小心肌损伤和中、晚期诊断cTnI测定优于心肌酶学.

Determination of cerum eardiac troponin I in acute myocardial infarction and its clinical signifi- cance.

Objective To study the diagnostic values of cardiac troponin I (cTnl) in acute mycardial infarction (AMI), we detected cTnl and serum enzymes (LDH, CK, CKMB) levels in the sera of patients with AMI. Methods: Solid- phase immunochromatographicassay and enzymicassay were used to measure cTnl and enzymes respectively. Results: The positive rate of cTnl in sera of 50 patients with AMI was 98. 00% which was significantly greater than those of in 21 patients with hypertension (0%) and 43 healthy persons (0%) (bothP<0. 0001). The sensitivity of serum enzymes was 83. 87% in 31 AMI patients with cTnl high - positive (>2μg/L), but was only 22. 22 % which was significantly lower than that of cTnI(P<0. 0001) in 18 cases with cTnl low-positive (0. 2 - 2/μg/L). In 15 AMI patients with cTnl high-positive, both aTnl and serum enaymes showed high positive rates (100 % , 80. 00%) in 2 days after onset of pain. Serum cTnl remained a higher positive rate (86. 67%) in 7- 10 days after onset and obviously decreased (36. 36%) after 10 days. The minority of cases persistented cTnl positive up to 3 weeks. However, the levels of serum enzymes significantly reduced (20. 00%) in 7- 10 days after onset of pain and the returned to normal after 10 days. Conclusions The measurement of serum cTnl has high specificity and sensitivity for diagnosing AMI. The sensitivity of cTnl was superior to serum enzymes for detection of minute myocyte injury and delayed diagnosis in AMI.