比较心肌酶与心肌蛋白对AMI早期诊断的评估作用

目的探寻对急性心肌梗死（AMI）诊断中敏感性、特异性均很强的金指标。方法选取50例AMI病患组I（分发病3h、24h、8d三个不同时间抽血）、50例骨胳肌重度损伤（无心肌损伤）病患组II50例肾功能衰竭（无心肌损伤）病患组Ⅲ、50例病毒性心肌炎病患组Ⅳ、50例正常对照组分别测定血清中cTnI、Mb、CMLC、CK—MB、CK、AST、LDH的含量或活性。结果I组和Ⅳ组中cTnI显著高于对照组（P〈0.001），Ⅱ组和IⅡ组中无变化（P〉0．05）；而Mb、CMLC、CK—MB、CK、AST、LDH在I组发病24h时、Ⅱ组和IⅡ组中均明显升高（P〈0．05），在I组患者发病3h和8d时，Ⅳ组中无明显变化（P〉0．05）。结论cTnI是诊断AMI敏感性高、特异性强的金指标，并适用于心肌损伤早期和后期的诊断。Mb与cTnI联合检测可作为早期诊断AMI的可靠指标。

Comparison Between Myocardial Enzyme and Myocardial Protein in Early Diagnosis of Acute Myocardial Infarction

Objective To explore the highly sensitive and specific gold- standard in diagnosis of acute myocardial infarction （AMI）. Methods Serum levels of cardiac troponin I （cTnI）, myoglobin （Mb）, cardiac myosin light chains （CM- LC）, MB - isoenzyme of creatine klnase （CK - MB）, creatine kinase （CK）, aspartate transaminase （AST） and lactic dehydrogenase （LDH） in 50 patients with AMI （group Ⅰ）, 50 severe skeletal muscle injury patients without myocardial injury （group Ⅱ）, 50 patients with renal function failure （group Ⅲ）, and 50 patients with viral myocarditis （group Ⅳ） were determined at the time points of 3 h, 24 h and 8 d after the disease onset; and 50 healthy subjects severed as normal control group. Results Serum level of cTnI was significantly higher in groups Ⅰ and Ⅱ than that in control group （P〈 0. 001）. Serum Mb, CMLC, OK - MB, OK, AST and LDH were significantly higher in groups I, II and III than those in control group （ P〈0.05 ） at 24 h, while no obvious changes were found in groups I and IV at the time points of 3 and 24 h after the disease onset. Cen- clusions Serum cTnI is a marker with high sensitivity and specificity for AMI and can aid in the early and later diagnosis of AMI. Combined detection of cTnI and Mb can be used as valuable markers in the early diagnosis of AMI.