高敏感性肌钙蛋白T检测在急性非ST段抬高型心肌梗死早期诊断中的意义

摘要

目的:探索高敏感性肌钙蛋白T(hs-cTnT)对急性非ST段抬高型心肌梗死(NSTEMI)的早期诊断价值.方法:入选88例发病在6h以内的高度怀疑非ST段抬高型急性冠脉综合征的患者,入院即刻抽取静脉血检测hs-cTnT,并与肌钙蛋白I(cTnI)及肌酸激酶同工酶(CK-MB)检测结果进行比较,诊断性能用ROC曲线及AUC表示,并根据hs-cTnT、cTnI和CK-MB的阳性率,得出对NSTEMI诊断的灵敏度、特异度等.结果:(1)NSTEMI患者hs-cTnT、cTnI及CK-MB明显高于不稳定型心绞痛患者(P ＜ 0.001).(2)根据ROC曲线分析,hs-cTnT、cTnI和CK-MB的AUC分别为0.908、0.851、0.789,95%可信区间分别为0.832 ～ 0.985、0.763 ～ 0.939、0.695 ～ 0.883.(3)hs-cTnT以14 pg/mL为诊断临界点时,灵敏度为77.8%,特异度为96.7%,阳性预测值为91.3%,阴性预测值为96.8%.而cTnI诊断临界点为0.08 ng/mL时,灵敏度为37.0%,特异度为96.7%,阳性预测值为83.3%,阴性预测值为77.6%.CK-MB以4 ng/mL 为诊断临界点时,灵敏度为25.9%,特异度为93.4%,阳性预测值为63.6%,阴性预测值为79.2%.结论:hs-cTnT对NSTEMI的早期诊断性能优于cTnI和CK-MB,有利于早期筛选NSTEMI患者并及时对其进行治疗.%Objective To determine the early diagnostic value of the new high-sensitivity cardiac troponin T (hs-cTnT) assay for non-ST-segment myocardial infarction (NSTEMI). Methods Eighty-eight patients were suspected ACS without ST-segment elevation admitted to the study. All the patients were admitted to hospital from the onset of symptoms within 6 hours. The blood samples were tested for hs-cTnT , cTnl and CK-MB at the same time. The diagnostic performance of them was assessed using ROC analysis. Based on the positive rate of the three cardiac markers, we inferred the sensitivity, specificity. Results (1) The levels of the three markers in NSTEMI patients were obviously higher than UA patients (P < 0.001). (2) The AUCs of hs-cTnT, cTnl and CK-MB were 0.908, 0.851,0.789, and the 95%CI of the three markers were 0.832-0.985, 0.763-0.939, 0.695-0.883. (3) Using 14 pg/mL as cut off value , the sensitivity and specificity of hs-cTnT were 77.8% and 96.7% , the positive predictive value and negative predictive value were 91.3% and 96.8% to diagnose NSTEMI. Using 0.08 ng/mL as cut off value , the sensitivity and specificity of cTnl were 37.0% and 96.7% , the positive predictive value and negative predictive value were 83.3% and 77.6% to diagnose NSTEMI. Using 4 ng/mL as cut off value , the sensitivity and specificity of CK-MB were 25.9% and 93.4% , the positive predictive value and negative predictive value were 63.6% and 79.2% to diagnose NSTEMI. Conclusions The hs-cTnT is better than cTnl and CK-MB in early diagnosis of NSTEMI, and benefit screening and early treatment of NSTEMI.