3种心肌标志物在急性心肌梗死早期诊断中的价值

目的探讨肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)3种心肌标志物检测对急性心肌梗死(AMI)早期诊断的价值。方法用胶体金免疫层析法测定120例心肌梗死患者的3种血清心肌标志物的浓度,比较其对AMI诊断的性能价值。结果 120例心肌梗死患者在胸痛发作6h内检测cTnT、CK-MB和MYO的敏感率分别是81.4%、60.5%和97.7%,以MYO浓度升高最快,出现最早;发病6h～24h内检测cTnT、CK-MB和MYO的敏感率分别是99.0%、79.4%和79.0%,以cTnT浓度最稳定;在发病8h内检测cTnT、CK-MB和MYO的敏感性分别为91.0%、70.0%和99.0%,特异性分别为100%、91.0%和79.0%;漏诊率分别是9.0%、30.0%和1.0%;误诊率分别是0、9.0%和21.0%。结论 cTnT在AMI早期诊断中具有较高的敏感性、特异性和准确性,是早期诊断AMI的"金指标",MYO可作为AMI的过筛,三者结合可提高早期AMI的诊断率,并有助于病情的分析。

The value of three cardiac markers in the early diagnosis of acute myocardial infarction

Objective To evaluate the value of three cardiac markers-troponin T(cTnT),creatine kinase(CK-MB),and myoglobin(MYO)-in the early diagnosis of acute myocardial infarction(AMI).Methods Levels of CTnT,CK-MB,and MYO were determined in 120 patients with AMI via colloidal gold immunochromatography;these markers were compared in terms of their value in diagnosing AMI.Results Patients with AMI were tested within six hours of chest pain.cTnT had a sensitivity of 81.4%,CK-MB had a sensitivity of 60.5%,and MYO had a sensitivity of 97.7%.The level of MYO rose the fastest.Within 6-24 hours of chest pain,cTnT had a sensitivity of 99.0%,CK-MB had a sensitivity of 79.4%,and MYO had a sensitivity of 79.0%.The level of cTnT was the most consistent.Within 8 hours of chest pain,cTnT had a sensitivity of 91.0% and specificity of 100.0%,CK-MB had a sensitivity of 70.0% and specificity of 91.0%,and MYO had a sensitivity of 99.0% and specificity of 79.0%.cTnT had a rate of missed diagnoses of 9.0% and rate of misdiagnosis of 0,CK-MB had a rate of missed diagnoses of 30.0% and rate of misdiagnosis of 9.0%,and MYO had a rate of missed diagnoses of 1.0% and rate of misdiagnosis of 21.0%.Conclusion cTnT had better sensitivity,specificity,and accuracy,making it the "gold standard" for early diagnosis of AMI.Together,the three markers can enhance the rate of early diagnosis of AMI and they can help to analyze the condition of patients.