床边快速肌钙蛋白T测定对急性胸痛患者诊断的价值

目的评价床边快速心肌肌钙蛋白T(cTnT)检测对以急性胸痛症状住院或转科的患者诊断的价值。方法采用床边快速心肌肌钙蛋白T测定仪(CARDIACREADER)测定502例以急性胸痛症状入院或转入心内科的患者入院即刻、6h、12h的cTnT水平,同时测定患者的心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶(CK)及其同功酶(CK-MB)水平。以心电图出现急性心肌梗死(AMI)的动态改变和(或)CK-MB和TnI同时升高诊断为心肌梗死,计算床边快速cTnT诊断急性心肌梗死的特异性、敏感性、阴性预测价值和阳性预测价值。结果502例急性胸痛患者,cTnT阳性160例(31.9%),cTnT阴性323例(64.3%),19例弱阳性。139例cTnT阳性患者发生AMI,7例cTnT阴性的患者发生AMI。床边快速cTnT对以急性胸痛症状住院或转科的患者诊断AMI的特异性为93.8%、敏感性为95.2%、阳性预测价值为86.9%、阴性预测价值为97.8%。结论床边快速肌钙蛋白T测定可以迅速准确地在急性胸痛患者中识别或排除AMI患者,具有重要的诊断价值。

The value of cardiac troponin T rapid test in diagnosis of acute chest pain

Objective To evaluate the value of bedside troponin T rapid test in diagnosis of acute chest pain. Methods 502 patients admitted with the syndrome of acute chest pain were evaluated. Bedside half-quantitative cTnT was test at admission, 6, 12 and 48 hours thereafter, quantitative cTnI, CK, CKMB were test at the same time also. Dynamic change at ECG and/or the value of CK-MB increased above three times of upper normal and TnI above 0.33 ng/L at the same time were recognized as AMI. The specificity, sensibility, predictive value of negative, predictive value of positive of cTnT rapid test were calculated respectively. Results Among 502 enrolled patients 160 (31.9%)patients had a positive cTnT, 323((64.3%) patients had a negative cTnT, 139 patients (86.9%) who had a positive cTnT meet the standard criteria of AMI, 7 patients (2.2%) who had a negative result occurred AMI. The specificity, sensibility, predictive value of negative and predictive value of positive of cTnT rapid test was 93.8%, 95.2%, 97.8% and 86.9% respectively. Conclusion Beside cTnT rapid test can identify or exclude patients with AMI exactly. It has great diagnostic value for patients with acute chest pain.