CAJ | 학술논문

目的评价hs-cTnT在AMI诊断中的临床应用价值.方法比较147例确诊AMI患者(其中122例为NSTEMI患者)入院即刻样本hs-cTnT、con-cTnT检出阳性率.检测481例胸痛患者入院5个不同时间点(入院即刻和入院后4、12、20和28 h)血清样本的hs-cTnT、con-cTnT、CKMB mass和MYO浓度,比较确诊AMI患者各指标不同时间点的检出阳性率.依据ROC曲线分析比较各心脏标志物对AMI的诊断特性.动态监测比较AMI组、非AMI心脏疾病组、AMI相关高危疾病组和表面健康对照组入院4 h内hs-cTnT浓度变化率.结果确诊AMI和NSTEMI患者人院即刻hs-cTnT的检出阳性率分别为90.3%和91.0%,明显高于con-cTnT的61.9%和60.6%(x2值分别为23.08、18.64,P均＜0.01).人院各时间点不同指标(hs-cTnT、con-cTnT、CKMB mass和MYO)检测中,hs-cTnT检出阳性率最高为100%(入院4 h后),con-cTnT最高为99.2%(入院12 h后),CKMB mass最高为92.1%(入院12 h后),MYO最高为74%(人院4 h后).hs-cTnT、con-cTnT、CKMB mass和MYO入院即刻的ROC曲线下面积(AUC)分别为0.935、0.851、0.827和0.769,hs-cTnT与con-cTnT、CKMB mass和MYO之间AUC差异均有统计学意义(Z1=3.13,Z2=4.46,Z3=5.62,P均＜0.05).动态监测AMI组变化率与其他3组变化率分别为203.03%(25.00%～2036.40%)、0.00%(-3.48%～5.21%)、0.00%(-1.17%～2.00%)、-1.97%(-3.83%～0.007%),差异有统计学意义(x2=166.09,P＜0.01).结论相比con-cTnT,hs-cTnT检测能够为AMI的更早期诊断提供可靠依据,减少NSTEMI患者的误诊或漏诊.单点hs-cTnT判断值结合动态监测变化明显优于仅仅使用单点判断值,hs-cTnT判断值结合动态监测变化的诊断特性明显优于单独使用判断值,有助于鉴别诊断因hs-cTnT检测灵敏度提高而增多的疑似AMI患者.由于具有良好的诊断特性,hs-cTnT检测可能使一些"早期标志物"的应用空问大大缩小.
목적 평개hs-cTnT재AMI진단중적림상응용개치.방법 비교147례학진AMI환자(기중122례위NSTEMI환자)입원즉각양본hs-cTnT、con-cTnT검출양성솔.검측481례흉통환자입원5개불동시간점(입원즉각화입원후4、12、20화28 h)혈청양본적hs-cTnT、con-cTnT、CKMB mass화MYO농도,비교학진AMI환자각지표불동시간점적검출양성솔.의거ROC곡선분석비교각심장표지물대AMI적진단특성.동태감측비교AMI조、비AMI심장질병조、AMI상관고위질병조화표면건강대조조입원4 h내hs-cTnT농도변화솔.결과 학진AMI화NSTEMI환자인원즉각hs-cTnT적검출양성솔분별위90.3%화91.0%,명현고우con-cTnT적61.9%화60.6%(x2치분별위23.08、18.64,P균＜0.01).인원각시간점불동지표(hs-cTnT、con-cTnT、CKMB mass화MYO)검측중,hs-cTnT검출양성솔최고위100%(입원4 h후),con-cTnT최고위99.2%(입원12 h후),CKMB mass최고위92.1%(입원12 h후),MYO최고위74%(인원4 h후).hs-cTnT、con-cTnT、CKMB mass화MYO입원즉각적ROC곡선하면적(AUC)분별위0.935、0.851、0.827화0.769,hs-cTnT여con-cTnT、CKMB mass화MYO지간AUC차이균유통계학의의(Z1=3.13,Z2=4.46,Z3=5.62,P균＜0.05).동태감측AMI조변화솔여기타3조변화솔분별위203.03%(25.00%～2036.40%)、0.00%(-3.48%～5.21%)、0.00%(-1.17%～2.00%)、-1.97%(-3.83%～0.007%),차이유통계학의의(x2=166.09,P＜0.01).결론 상비con-cTnT,hs-cTnT검측능구위AMI적경조기진단제공가고의거,감소NSTEMI환자적오진혹루진.단점hs-cTnT판단치결합동태감측변화명현우우부부사용단점판단치,hs-cTnT판단치결합동태감측변화적진단특성명현우우단독사용판단치,유조우감별진단인hs-cTnT검측령민도제고이증다적의사AMI환자.유우구유량호적진단특성,hs-cTnT검측가능사일사"조기표지물"적응용공문대대축소.
Objective To evaluate the clinical application of hs-cTnT in diagnosis of AMI. Methods The detectable rates of hs-cTnT and con-cTnT from 147 AMI ( including 122 NSTEMI )patients on immediate admission were compared. The related biological markers including hs-cTnT, con-cTnT, CKMB mass and MYO were determined for all samples from 481 patients with chest pain on immediate admission and 4 h, 12 h ,20 h and 28 h after admission. The receiver operating characteristic curve was used to evaluate the sensitivity and specificity of all markers. The change rates of hs-cTnT within 4 hours from AMI group, non-AMI heart disease group, AMI related high risk disease group and control group were compared with serial detection. Results The detection rates of hs-cTnT for AMI and NSTEMI patients were 90. 3% and 91.0%, and both were significantly higher than the rates of con-cTnT, which were 61.9% and 60. 6% (x2 =23.08,18. 64,all P＜0. 01 ). Among different makers obtained from different collecting times,hs-cTnT had the highest detection rate. For admission cases, the area under curve of hs-cTnT, con-cTnT,CKMB mass and MYO were 0.935, 0.851, 0.827 and 0.769 respectively, and the differences have statistical significance(Z1 = 3. 13, Z2 = 4. 46, Z3 = 5.62, all P ＜ 0. 05 ). Besides, there was a significant difference between the change rate of hs-cTnT of AMI and other groups (x2=166.09,P＜0. 01).Conclusions In comparison with con-cTnT, hs-cTnT could provide reliable results for earlier diagnosis of AMI, and could also reduce misdiagnosis and missed diagnosis of NSTEMI. Combining single test of hs-cTnT with serial tests was superior to using cut-off value alone in diagnosis. Moreover, it could be helpful to distinguish non-AMI patients from true AMI patients due to the improved detection sensitivity. Because of its good diagnostic performance, hs-cTnT test may limit the application value of some other "early markers".