急性心肌梗死病人血清心肌损伤标志物和C-反应蛋白的动态变化与诊断价值
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摘要
目的探讨血清心肌损伤标志物和C-反应蛋白(CRP)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-MB和Mb浓度的变化,与40例对照组进行比较,并对血清cTnI、CK-MB和Mb浓度进行了受试者工作特征曲线(ROC)分析。同时也检测了40例AMI病人血清超敏-C反应蛋白(hs-CRP)浓度变化,并与对照组和40例不稳定心绞痛病人(UAP)进行比较。
结果①AMI病人胸痛发作后不同时间的血清cTnI、CK-MB浓度明显高于对照组(F=72.679,109.768,q=3.049～27.652,P＜0.01),且胸痛发作后不同时间浓度变化之间的比较,差异有显著性(F=72.679,109.768,q=2.863～22.133,P＜0.05,0.01);胸痛发作后3～6h、24h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)。cTnI、CK-MB对诊断AMI的灵敏度、特异性、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3～6h血清CK-MB对诊断AMI的准确度高于cTnI和Mb,24h、3d血清CK-Mb与cTnI诊断AMI的准确度相同,但优于Mb,而胸痛发作后7d时cTnI对AMI诊断的准确度明显优于CK-MB。AMI病人胸痛发作后3～6h和24h时的cTnI、CK-MB的ROC曲线下的面积(AUC~(ROC))高于Mb,7d时cTnI的AUC~(ROC)高于CK-MB,且不同时间的cTnI和CK-MB的AUC~(ROC)均大于0.9。②AMI病人血清hs-CRP的浓度明显升高,与对照组和UAP组比较有显著性差异(F=40.487,q=11.884,9.883,p＜0.01)。
结论血清cTnI、CK-MB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,hs-CRP浓度的变化对急性冠脉事件的发生发展有一定的预测价值。
Objective To explore the diagnostic value on serum myocardial damage markers and C-reactive protein of the dynamic changes in acute myocardial infarction (AMI).
Methods The serum cTnI,CK-MB and Mb of 40 patients with AMI at different times were determined by enzyme-linked immunosorbent assay(ELISA),Forty healthy subjects servered as controls.At the same time the serum concentration of cTnI,CK-MB and Mb were analysised by receiver operating characteristic(ROC) curve.And the concentration of high-sensitivity C-reactive protein(hs-CRP) was measured in 40 patients with AMI by ELISA method,and compared with control group and 40 patients with unstable angina pectoris(UAP).
Results①The serum cTnI,CK-MB and Mb concentration of AMI patients after the onset of chest pain at different times were higher than that of the control group(F= 72.679,109.768,q=3.049-27.652,P＜0.01).The concentration changes of different time after onset of chest pain had also significant difference(F=72.679,109.768,q= 2.863-22.133,P＜0.05,0.01).The serum Mb concentration of chest pain onset after 3-6h,24h was significantly higher than that of chest pain onset after 3 days and 7 days(F =17.729,q=6.175-8.688,P＜0.01).The sensitivity,specificity,accuracy,Yuedeng index,positive predictive value(PPV)and negative predictive value(NPV) of CK-MB, cTnI to diagnosis of AMI were significantly higher than that Mb.The diagnosis accuracy of serum CK-MB was higher than cTnI and Mb,when patients chest pain onset after 3 to 6h.The diagnosis accuracy of serum cTnI and CK-MB of 24h and 3d were the same,but better than Mb.Chest pain onset after 7 days the diagnosis accuracy of cTnI to AMI was better than CK-MB.The area under the ROC curve(AUC~(ROC)) of CK-MB and cTnI were higher than Mb,when chest pain onset after 3-6h and 24h.The AUC~(ROC) of cTnI was higher than CK-MB,when chest pain onset after 7 days.And different times of the AUC~(ROC) of CK-MB and cTnI are greater than 0.9.②The concentration of hs-CRP in patients with AMI was higher than that of the control group and patients with UAP(F= 40.487,q=11.884,9.883,p＜0.01).
Conclusion The dynamic changes of CK-MB,cTnI and Mb concentration had obvious value and higher accuracy on the the diagnosis of AMI.The changes of hs-CRP concentration had predictive value on the incidence of major cardiac events.
方法采用ELISA法检测了40例AMI病人不同时间血清cTnI、CK-MB和Mb浓度的变化,与40例对照组进行比较,并对血清cTnI、CK-MB和Mb浓度进行了受试者工作特征曲线(ROC)分析。同时也检测了40例AMI病人血清超敏-C反应蛋白(hs-CRP)浓度变化,并与对照组和40例不稳定心绞痛病人(UAP)进行比较。
结果①AMI病人胸痛发作后不同时间的血清cTnI、CK-MB浓度明显高于对照组(F=72.679,109.768,q=3.049～27.652,P＜0.01),且胸痛发作后不同时间浓度变化之间的比较,差异有显著性(F=72.679,109.768,q=2.863～22.133,P＜0.05,0.01);胸痛发作后3～6h、24h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)。cTnI、CK-MB对诊断AMI的灵敏度、特异性、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3～6h血清CK-MB对诊断AMI的准确度高于cTnI和Mb,24h、3d血清CK-Mb与cTnI诊断AMI的准确度相同,但优于Mb,而胸痛发作后7d时cTnI对AMI诊断的准确度明显优于CK-MB。AMI病人胸痛发作后3～6h和24h时的cTnI、CK-MB的ROC曲线下的面积(AUC~(ROC))高于Mb,7d时cTnI的AUC~(ROC)高于CK-MB,且不同时间的cTnI和CK-MB的AUC~(ROC)均大于0.9。②AMI病人血清hs-CRP的浓度明显升高,与对照组和UAP组比较有显著性差异(F=40.487,q=11.884,9.883,p＜0.01)。
结论血清cTnI、CK-MB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,hs-CRP浓度的变化对急性冠脉事件的发生发展有一定的预测价值。
Objective To explore the diagnostic value on serum myocardial damage markers and C-reactive protein of the dynamic changes in acute myocardial infarction (AMI).
Methods The serum cTnI,CK-MB and Mb of 40 patients with AMI at different times were determined by enzyme-linked immunosorbent assay(ELISA),Forty healthy subjects servered as controls.At the same time the serum concentration of cTnI,CK-MB and Mb were analysised by receiver operating characteristic(ROC) curve.And the concentration of high-sensitivity C-reactive protein(hs-CRP) was measured in 40 patients with AMI by ELISA method,and compared with control group and 40 patients with unstable angina pectoris(UAP).
Results①The serum cTnI,CK-MB and Mb concentration of AMI patients after the onset of chest pain at different times were higher than that of the control group(F= 72.679,109.768,q=3.049-27.652,P＜0.01).The concentration changes of different time after onset of chest pain had also significant difference(F=72.679,109.768,q= 2.863-22.133,P＜0.05,0.01).The serum Mb concentration of chest pain onset after 3-6h,24h was significantly higher than that of chest pain onset after 3 days and 7 days(F =17.729,q=6.175-8.688,P＜0.01).The sensitivity,specificity,accuracy,Yuedeng index,positive predictive value(PPV)and negative predictive value(NPV) of CK-MB, cTnI to diagnosis of AMI were significantly higher than that Mb.The diagnosis accuracy of serum CK-MB was higher than cTnI and Mb,when patients chest pain onset after 3 to 6h.The diagnosis accuracy of serum cTnI and CK-MB of 24h and 3d were the same,but better than Mb.Chest pain onset after 7 days the diagnosis accuracy of cTnI to AMI was better than CK-MB.The area under the ROC curve(AUC~(ROC)) of CK-MB and cTnI were higher than Mb,when chest pain onset after 3-6h and 24h.The AUC~(ROC) of cTnI was higher than CK-MB,when chest pain onset after 7 days.And different times of the AUC~(ROC) of CK-MB and cTnI are greater than 0.9.②The concentration of hs-CRP in patients with AMI was higher than that of the control group and patients with UAP(F= 40.487,q=11.884,9.883,p＜0.01).
Conclusion The dynamic changes of CK-MB,cTnI and Mb concentration had obvious value and higher accuracy on the the diagnosis of AMI.The changes of hs-CRP concentration had predictive value on the incidence of major cardiac events.
引文
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