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学科主题: 临床检验诊断学
题名:
高敏心肌肌钙蛋白T在急性心肌梗死早期诊断中的临床价值
其他题名: Clinical value of high sensitivity cardiac troponin T in the diagnosis of acute myocardial infarction
作者: 杨硕; 怀伟; 刘桂花; 吴健; 张捷
关键词: 急性冠状动脉综合征 ; 心肌梗死 ; 肌钙蛋白T ; 敏感性与特异性 ; Acute coronary syndrome ; Myocardial infarction ; Troponin T ; Sensitivity and specificity
刊名: 中华检验医学杂志
发表日期: 2014
DOI: 10.3760/cma.j.issn.1009-9158.2014.02.019
卷: 37, 期:2, 页:150-154
收录类别: 中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 建立临床适用的高敏心肌肌钙蛋白T (hs-cTnT)诊断急性心肌梗死(AMI)的临界值和最佳联合检测方案,以期最大限度的体现其在AMI早期诊断中的临床价值.方法 前瞻性研究.选取2012年6月至2013年6月就诊于北京大学第三医院急诊科的胸痛、胸闷、心前区不适患者342例以及慢性肾脏病患者43例、肺炎患者40例、早产儿动脉导管未闭(PDA)患者18例.检测胸痛患者就诊即刻血浆hs-cTnT、N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)以及和肽素浓度.分析不同疾病组hs-cTnT水平,绘制受试者工作特征曲线(ROC)评估比较hs-cTnT和cTnI对于早期诊断AMI的价值和联合检测hs-cTnT、CK-MB、NT-proBNP、和肽素对于提高AMI早期诊断准确性的作用.统计学方法计算hs-cTnT诊断AMI的敏感度、特异度、阴性预测值和阳性预测值等指标.结果 ST抬高型心肌梗死(STEMI)组hs-cTnT水平最高(中位数为0.52μg/L,范围为0.037 ~7.610 μg/L),其次为非ST抬高型心肌梗死(NSTEMI)组(中位数为0.127 5μg/L,范围为0.021 ~4.260 μg/L),但其他疾病组hs-cTnT亦出现不同程度的增高(Chi-square=76.432,P< 0.05).hs-cTnT诊断AMI性的ROC曲线下面积(AUC)为0.862 (95% CI:0.900 ~0.989),床旁检测(POCT) cTnI的AUC为0.748(95% CI:0.666 ~0.818)(Z=2.713,P<0.05).以0.014 μg/L作为诊断界值(cut-off)诊断AMI的敏感度高达100%,但特异度仅为44.4%.以0.035μg/L作为cut-off值的Youden指数最高,敏感度为95.1%,特异度为65.7%.联合hs-cTnT、NT-proBNP和CK-MB使AUC提高至0.915 (95% CI:0.838 ~0.964) (Z =2.147,P<0.05),hs-cTnT与和肽素联合检测使AUC提高至0.921 (95% CI:0.820 ~0.975) (Z =2.589,P<0.05).结论 以0.035 μg/L作为AMI的诊断界值为宜,且多项实验室指标联合检测可有效提高AMI早期诊断的准确性. Objective To establish an appropriate cut-off value of high sensitivity cardiac troponin T (hs-cTnT) and optimal combination measurement in the early diagnosis of acute myocardial infarction (AMI).Methods This research is a prospective study.342 patients admitted to emergency department with chest pain,43 patients with renal failure,40 patients with pneumonia and 18 premature with patent ductus arteriosus were involved from June 2012 to June 2013 in Peking University Third Hospital.The plasma hs-TnT,NT-proBNP,cardiac troponin Ⅰ (cTnI),CK-MB and copeptin were measured.The distribution of hs-cTnT among associated diseases was analyzed,the diagnostic performance of hs-cTnT and the role of combination hs-cTnT with NT-proBNP,CK-MB and copeptin were evaluated by receiver operating characteristic (ROC) curve.The statistical method was used to calculate the Sensitivity,specificity,negative predictive value and positive predictive value of hs-cTnT in the diagnosis of AMI.Results As compared to patients with STEMI(median 0.52 μg/L,range 0.037-7.610 μg/L),hs-cTnT was lower in the patients with Non-STEMI(median 0.127 5 μg/L,range 0.021-4.260 μg/L).However,the levels of hs-TnT in other diseases were also increased increased in varyng degrees (Chi-square =76.432,P < 0.05)The areas under the curve (AUC) for hs-cTnT and cTnI in the diagnosis of AMI were 0.862 (95% CI:0.729-0.928) and 0.748 (95% CI0.666-0.818) respectively (Z =2.713,P < 0.05).Taking 0.014μg/L and 0.035 μg/L as cut-off value of hs-TNT,the sensitivities were 100% vs 95.1%,the specificities were 44.4% vs 65.7%.The combination of hs-cTnT,NT-proBNP,CK-MB resulted in a increase in AUC (0.915,95% CI:0.838-0.964) (Z =2.147,P < 0.05) and the combination of hs-cTnT and copeptin resulted in a increase in AUC 0.921 (95% CI:0.820-0.975) (Z =2.589,P < 0.05).Conclusion With the cut-off value of 0.035 μg/L for diagnosis of AMI was appropriate,and the combination measurement can improve the accuracy of early diagnosis of AMI.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/71532
Appears in Collections:北京大学第三临床医学院_检验科_期刊论文

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作者单位: 1.100194,北京大学第三医院检验科
2.100194,北京大学第三医院急诊科

Recommended Citation:
杨硕,怀伟,刘桂花,等. 高敏心肌肌钙蛋白T在急性心肌梗死早期诊断中的临床价值[J]. 中华检验医学杂志,2014,37(2):150-154.
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