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1、血清cTnKCKMB和Mb浓度动态变化对急性心肌梗死的诊断价值【摘要】目的探讨血清心肌肌钙蛋白I(cTnl)、肌酸激酶同工酶(CKMB)和肌红蛋白(Mb)浓度的动态变化对急性心肌梗死(AMI)的诊断价值。方法采用ELISA法检测了40例AMI病人不同时间血清cTnLCKME和Mb浓度的变化，同时对血清cTnLCKMB和Mb浓度进行了受试者工作特征曲线(ROC)分析。以40例健康查体者作对照。结果AMI病人胸痛发作后不同时间的血清cTnl、CKMB浓度明显高于对照组(F=72・679、109.768,q=
2、3.049-27.652,P<0.01),且胸痛发作后不同时间浓度比较，差异有显著性(q=2・863〜22.133,P<0・05、0.01);胸痛发作后3〜6h、Id血清Mb浓度明显高于对照组、胸痛发作后3d和7d(F=17.729,q=6.175-8.688,P<0.01)o且cTnLCKME对诊断AMI的灵敏度、特异度、准确度、约登指数、阳性预测值(PPV)和阴性预测值(NPV)明显高于MboAMI病人胸痛发作后3~6h血清CKMB对诊断AMI的准确度高于cTnl和Mb,1d、3d
3、血清CKME与cTnl诊断AMI的准确度相同，但优于Mb,而胸痛发作后7d时cTnl对AMI诊断的准确度明显优于CKMBoAMI病人胸痛发作后3~6h和1d时cTnLCKMB的AUCROC高于Mb,7d时cTnl的AUCROC高于CKMB,且不同时间的cTnl和CKMB的态变化对AMI具有明显的诊断价值和较高的准确度。【关键词】心肌梗死肌钙蛋白肌酸激酶肌红蛋白实验室技术和方法[ABSTRACT]ObjectiveToassessthevalueofdynamicchangesofserumcreatin
4、ekinaseisoenzyme(CKMB),cardiactroponinI(cTnl),andmyoglobin(Mb)inthediagnosisofacutemyocardialinfarction(AMI)・MethodsTheserumcTnl,CKMBandMbof40patientswithAMIatchfferenttimeweredeterminedbyenzymelinkedimmunosorbentassay,40healthysubjectsserveredascontrols
5、・TheserumcTnl,CKMBandMbwereanalyzedbyreceiveroperatingcharacteristic(ROC)curve・ResultsTheserumcTnl,CKMBandMbconcentrationofAMIpatientsa仕ertheonsetofchestpainatdifferenttimewashigherthanthatofthecontrols(F=72.679,109.768;q=3.049-27.652;P<0.01),andthedi
6、fferenceoftheconcentrationsatdifferenttimea仕erchestpainwassignificant(q=2.863-22.133;P<0.05,0.01).TheserumMbat3-6hafterchestpainwassignificantlyhigherthanthatofafter3and7days(F=17.729,q=6.175-8.688,P<0.01).CKMbandcTnlweresuperiortoMbinthediagnosiso
7、fAMIintermsofsensitivity,spec辻icity,accuracy,Yuedengindex,positivepredictivevalue(PPV)andnegativepredictivevalue(NPV).ThediagnosticaccuracyofserumCKMBwashigherthancTnlandMbafter3to6hofchestpain.ThediagnosticaccuracyofserumcTnlandCKMBof1and3dayswassame,bu
8、tbetterthanMb.TheaccuracyofdiagnosisofcTnlforAMIwasbetterthanCKMBat7dayslaterofchestpain.TheareaundertheROCcurve(AUCROC)ofCKMBandcTnlwashigherthanMb,whenchestpainonsetafter3-6hand1d.TheAUCROCofcTnlwashigherthanCKMB,whenche
