血清cTnI、CKMB和Mb浓度动态变化对急性心肌梗死的诊断价值_医学论文.docVIP

血清cTnI、CK和Mb浓度动态变化对急性心肌梗死的诊断价值_医学论文 血清cTnI、CK和Mb浓度动态变化对急性心肌梗死的诊断价值_医学论文 【摘要】 　　目的 探讨血清心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK）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cTnI、CK和Mb浓度的变化，同时对血清cTnI、CK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cTnI、CK浓度明显高于对照组（F=72.679、109.768，q=3.049～27.652，0.01），且胸痛发作后不同时间浓度比较，差异有显著性（q=2.863～22.133，0.05、0.01）；胸痛发作后3～6 h、1 d血清Mb浓度明显高于对照组、胸痛发作后3 d和7 d（F=17.729，q=6.175～8.688，0.01）。且cTnI、CK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Mb。AMI病人胸痛发作后3～6 h血清CK对诊断AMI的准确度高于cTnI和Mb，1 d、3 d血清CK与cTnI诊断AMI的准确度相同，但优于Mb，而胸痛发作后7 d时cTnI对AMI诊断的准确度明显优于CK。AMI病人胸痛发作后3～6 h和1 d时cTnI、 CK的AUCROC高于Mb，7 d时cTnI的AUCROC高于CK，且不同时间的cTnI和CK的AUCROC均大于0.9。结论 血清cTnI、CK和Mb浓度的动态变化对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］ Objective To assess the value of dynamic changes of serum creatine kinase isoenzyme (CKs with AMI at different time were determined by enzymelinked immunosorbent assay, 40 healthy subjects servered as controls. The serum cTnI, CKMB and Mb were analyzed by receiver operating characteristic (ROC) curve. ResultsThe serum cTnI, CKMB and Mb concentration of AMI patients after the onset of chest pain at different time was higher than that of the controls (F=72.679,109.768q=3.049-27.6520.01), and the difference of the concentrations at different time after chest pain was significant (q=2.863-22.1330.05,0.01). The serum Mb at 3-6 h after chest pain was significantly higher than that of after 3 and 7 days (F=17.729,q=6.175-8.688,0.01). CKMb and cTnI were superior to Mb in the diagnosis of AMI in terms of sensitivity,specificity, accuracy,Yuedeng index,positive predictive value(PPV)and negative predictive value (NPV). The diagnostic accuracy of serum CKMB was higher than cTnI and Mb after 3 to 6 h of chest pain. The diagnostic accuracy of serum cTnI and CKMB of 1 and 3 days was same,but better than Mb. The accuracy of diagnosis of cTnI for AMI was better than CKMB at 7 days later of chest pain. The area und