摘要
目的探讨高敏心肌肌钙蛋白T（hs-cTnT）、N末端脑钠肽前体（NT-proBNP）及高敏C-反应蛋白（hs-CRP）联合检测诊断AMI的临床价值。方法选取收治的AMI患者99例,其中STEMI 76例,NSTEMI 23例,另选无心血管、肺、肾等器质性疾病及急慢性炎症,ECG正常的体检健康者100例为对照组。比较2组人员入院即刻血清hs-cTnT、NT-proBNP及hs-CRP水平,通过绘制ROC曲线比较检测的准确度,并运用统计学方法探讨临床适用的hscTnT诊断临界值。结果AMI患者hs-cTnT水平为0.027-4.019 mg/L,均高于健康人群第99百分位值（0.014 mg/L）,提示hs-cTnT阴性可排除AMI诊断;AMI患者hs-cTnT、NT-proBNP及hs-CRP水平均显著高于对照组（P〈0.01）且STEMI患者相关指标水平显著高于NSTEMI患者（P〈0.01）;当以0.035 mg/L为临界值时诊断AMI灵敏度为94.7%,而特异度有较大提升,高至66.3%,此时反映试验真实性的Youden值最大,为0.610,提示以此为最佳临界值早期诊断AMI的临床价值最好;ROC曲线表明联合检测的曲线下面积为0.911,大于单纯hs-cTnT检测的曲线下面积0.887（P〈0.05）及POCT检测的曲线下面积0.828（P〈0.05）。结论 hs-cTnT作为心肌损伤特异性蛋白,对于AMI早期诊断具有良好的敏感性和特异性,联合NT-proBNP、hs-CRP等指标对于早期诊断AMI具有重要临床价值,值得临床推广应用。
Objective To investigate the clinical significance of combination detection of hs-cTnT,NT-pro BNP,hs-CRP in diagnosis of acute myocardial infarction（ AMI）. Methods Ninety- nine patients with AMI including 76 cases of STEMI and 23 cases of NSTEMI were enrolled into observation group,and 100 healthy subjects were served as control group.The instant serum levels of hs-cTnT,NT-pro BNP and hs-CRP were detected and compared between two groups,and detection accuracy was determined by drawing ROC curves,moreover,diagnostic critical value of hs-cTnT was explored through statistical methods. Results The levels of hs-cTnT,NT-pro BNP and hs-CRP in observation group were significantly higher than those in control group（ P 〈0. 01）,besides,the levels of related indexes in STEMI patients were significantly higher than those in NSTEMI patients（ P〈 0. 01）. When the diagnostic critical value was 0. 035 mg / L,the diagnostic sensitivity was 94. 7%,however,the specificity was increased to 66. 3%,and Youden was 0. 610,which suggested that it was the best critical value for early diagnosis of AMI. ROC curve showed that the area under curve of combined detection was 0. 911,which was higher than that（ 0. 887） of the area under curve of simple hs-cTnT detection and that（ 0. 828） of the area under curve of POCT detection（ P〈0. 05）,which demonstrated that the diagnostic accuracy of combination detection for early diagnosis of AMI was the highest. Conclusion The combination detection of hs-cTnT,NT-pro BNP,hs-CRP has important clinical value in early diagnosis of AMI,thus,which is worthy to be widely applied in clinic.
出处
《河北医药》
CAS
2015年第23期3541-3543,共3页
Hebei Medical Journal
