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1、CTn-I、Mb、CK-MB对心肌梗死的辅助诊断【摘要】目的为了进一步检测肌钙蛋白(cardiactroponin-I,CTn-I)、肌红蛋白(myoglobin,Mb)、肌酸激酶同工酶MB(creatinekinaseisoenzymeMB,CK-MB)在不同的胸痛持续时间后诊断急性心肌梗死的敏感性和特异性,并与心电图ST段有无改变相对比,以期为怀疑心梗的患者制定最快速的确诊方案。方法对164例疑为急性心梗患者做了回顾性调查分析,依据入院时胸痛持续时间及有无心电图ST段的抬高分组比较其CTn-I、Mb、CK-MB的阳性率及阴性率
2、,以及在各时段用CTn-I、Mb、CK-MB诊断AMI的敏感性及特异性进行了比较。结果结果显示在入院时胸痛持续2h内心电图是较好的指标,而在2h后,其敏感性明显地低于上述三个生化指标,在特异性方面则明显不如CTn-I,辅助利用这几项指标可以明显地提高AMI的诊出率(提高23.2%)。结论在疑为AMI的急诊患者做了心电图检查后,及时做CK-MB、Mb、CTn-I的检查及动态观察能提高确诊率(确定是AMI或非AMI),可以为患者接受及时正确的治疗保障时间。【关键词】急性心肌梗死诊断CTn-ICK-MBMb心电图【Abstract】Ob
3、jectiveToverifythesensitivityandspecificityofserumcardiactroponin-I(CTn-I),creatinekinaseisoenzymeMB(CK-MB)andmyglobin(Mb)fordiagnosisofacutemyocardialinfarction(AMI)amongthepatientswith10differentdurationofchestpainandsuspectedtobeAMI,andwhetherCTn-I,CK-MBandMbhaveso
4、meadvantageofimprovingtheaccuracyofdiagnosiscomparingtoECG-STelevationinsensitivity,uponwhichanfasterandmoreexactprojectwashopedtobeputonandtobehelpfultodiagnoseAMI.MethodsAretrospectivestudyof164casesconsecutivelywhichhadasymptomofchestpaininemergencyandsuspectedtobe
5、AMIwereconducted,accordingtothelastedandwhetherhadanelevationofECG-ST,thepatientsweregrouped,thepositiverateandnegativeratewerecompared,meanwhile,thesensitivityandspecificityofCTn-I,CK-MB,MbandECG-STamongthesedifferentgroupswerealsocompared.ResultsTheresultsshowedthat
6、theitemofECG-STwasthebesttothepatientswithachestpainlastedlessthan2hours,andalongwiththetimelasted,thesensitivityofECG-STwaslessthanMb,CTn-IandCK-MB,thespecificitywaslessthanCTn-I,theresultsalsoshowediftheMb,CTn-IandCK-MBwerecombined,theaccuracyofdiagnosiswouldbemuchi
7、mproved.ConclusionTothepatientsofsuspicioustobeAMI,conductedanexaminationofMb,CTn-TandCK-MBtimelywouldimprovetheaccuracyofdiagnosis(beAMIornon-AMI),meanwhile,thetimewouldbemuchmoreeconomized.10【Keywords】acutemyocardialinfarction;diagnosis;CTn-I;CK-MB;Mb;ECG大约50%的心肌梗死(
8、acutemyocardialinfarction,AMI)患者心电图检查无ST段抬高[1],这些患者中有60%存在急性冠状动脉阻塞[2]。对于AMI患者,应及早明确诊断并进行溶栓治疗,使患者脱离危险期。长期以来肌红蛋白(myoglobin,Mb)