血清Troponin I, CK-MBmass, Myoglobin在急性心肌梗塞诊断中的应用评价

为了解CTnI,CK-MBmass 和Mb指标对急性心肌梗塞(AMI)早期诊断、后期监测及预后判断的临床意义,采用微粒子化学发光法,对20例AMI患者、24例不稳定心绞痛(UA)患者、17例骨骼肌损伤(SM)患者和19例健康者(对照组)进行血清CTnI,CK-MBmass 和Mb的测定,并对AMI患者胸痛发生3～5小时,8～14小时,20～24小时,72小时和7天共五个时段进行了测定.结果:AMI患者发病早期CTnI,CK-MBmass 和Mb的阳性检出率分别为65%,70%,70%,CTnI在UA患者组和SM患者组中未检出.CTnI,CK-MBmass 和Mb测定值含量在AMI组中明显高于UA组和SM组,AMI患者组CTnI分别是UA组和SM组的84倍和91.63倍,CK-Mbmass分别是该二组的8.82倍和4.67倍, Mb分别是该二组的11.57倍和2.25倍,AMI组与UA组和SM组比较,有显著性差异(P＜0.001).AMI患者组中该三项指标的动态测定显示,在疾病发生早期(3～5小时)时,CTnI,CK-MBmass 和Mb都有显著性升高,随时间延长而逐渐升高,高峰值期均在8～14小时段,72 小时时Mb已基本回到正常.7天时血清中仍有CTnI的持续存在,但CK-MBmass已接近正常.以上显示,CTnI ,CK-MBmass 和Mb在早期诊断AMI时,都具有较高的敏感性,CTnI在AMI患者中的阳性检出率具有心肌特异性.CK-MBmass 和Mb在诊断心肌损伤时也具有较高的临床价值.但CTnI具有最长的窗口时间,在选择用于AMI的后期监护和愈后判断指标时,CTnI应是最佳的首选指标.

Evaluation on Usage of Serum Troponin-I, CK-MBmass and Myoglobin Measurments in Diagnosing Acute Myocardial Infarction

The purpose of this study was to search the sensitivity of three indicators in early diagnosis of acute myocardial infarction (AMI) and analyze their window-time duration in serum, along with the decision on experimental golden indicator in later AMI inspection and effect assessment after recovery by testing the concentrations of CTnI, CK-MBmass and Mb in AMI patients' serum. By using corpuscle chemiluminescence, the serum concentrations of CTnI, CK-MBmass and Mb in AMI patients, UA (unstable angina ) patients, SM (skeletal muscle) patients and a normal group were assayed and compared. A dynamic analysis was followed in five periods, which separately focused on 3-5, 8-14, 20-24, 72 hours and 7 days after heart aching occurred in AMI patients. The results showed the positive rates of CTnI, CK-MBmass and Mb in AMI patients were 65 %, 70% and 70% respectively, and the positive rate of CTnI in UA and SM groups was 0%. The CTnI, CK-MBmass and Mb values in group AMI were significantly higher than those in groups of UA and SM. Separately, the CTnI value in AMI was 84 and 91. 63 times (the CTnI values) in UA and SM l the CK-MBmass value in AMI was 8. 82 and 4.67 times and the Mb value in AMI was 11. 57 and 2. 25 times as high as those in UA and SM. Significantdifference was observed by the comparison between AMI group and UA, SM groups (P<0.001). According to the dynamic analysis, CTnI, CK-MBmass and Mb rose significantly at the early stage of AMI onset (3-5 hrs), and then gradually increased with time. The climax occurred in the period of 8-14 hrs and Mb returned to its normal state in 72 hrs. on the 7th day, CTnI still existed in serum, but CK-MBmass approximated to normality. In conclusion, these data demonstrate a relatively high sensitivity of CTnI, CK-MBmass and Mb in early diagnosis of AMI. CTnI is specific to cardiac muscle for its special positive rate. Also, CK-MBmass and Mb are of higher clinical value in diagnosing cardiac muscle damage. CTnI has the longest window-time, which makes it the best special indicator for terminal inspection and recovery decision on AMI.