实用医学杂志
實用醫學雜誌
실용의학잡지
THE JOURNAL OF PRACTICAL MEDICINE
2014年
19期
3096-3098,3099
,共4页
张浩%任国庆%孙文文%尹江宁
張浩%任國慶%孫文文%尹江寧
장호%임국경%손문문%윤강저
心肌梗死%和肽素%非ST段抬高%肌钙蛋白I%心绞痛%早期诊断
心肌梗死%和肽素%非ST段抬高%肌鈣蛋白I%心絞痛%早期診斷
심기경사%화태소%비ST단태고%기개단백I%심교통%조기진단
Myocardial Infarction%Copeptin%Non-ST Segment elevation%cTnI%Angina%Early diagnosis
目的：评价检测和肽素（copeptin）及肌钙蛋白I（cTnI）在急性非 ST 段抬高型心肌梗死（NSTEMI）早期诊断中的价值。方法：176例发病在6 h以内、疑诊NSTEMI的患者分为NSTEMI组40例、心绞痛组56例、其他诊断80例。 ROC曲线评估和肽素及cTnI的诊断性能。结果：（1）NSTEMI组和肽素水平、cTnI阳性率明显高于其他各组（P＜0．05）。（2）和肽素诊断临界点时为10．85 pmol/L，灵敏度为90％，特异度为64％。cTnI诊断临界点为0．05 ng/mL时，灵敏度为42．5％，特异度为94．1％。（3）和肽素＜10．85 pmol/L联合cTnI＜0．05 ng/mL 对NSTEMI阴性预测值为97．7％。结论：联合检测和肽素及cTnI对NSTEMI的早期诊断性能优于单独检测cTnI。
目的：評價檢測和肽素（copeptin）及肌鈣蛋白I（cTnI）在急性非 ST 段抬高型心肌梗死（NSTEMI）早期診斷中的價值。方法：176例髮病在6 h以內、疑診NSTEMI的患者分為NSTEMI組40例、心絞痛組56例、其他診斷80例。 ROC麯線評估和肽素及cTnI的診斷性能。結果：（1）NSTEMI組和肽素水平、cTnI暘性率明顯高于其他各組（P＜0．05）。（2）和肽素診斷臨界點時為10．85 pmol/L，靈敏度為90％，特異度為64％。cTnI診斷臨界點為0．05 ng/mL時，靈敏度為42．5％，特異度為94．1％。（3）和肽素＜10．85 pmol/L聯閤cTnI＜0．05 ng/mL 對NSTEMI陰性預測值為97．7％。結論：聯閤檢測和肽素及cTnI對NSTEMI的早期診斷性能優于單獨檢測cTnI。
목적：평개검측화태소（copeptin）급기개단백I（cTnI）재급성비 ST 단태고형심기경사（NSTEMI）조기진단중적개치。방법：176례발병재6 h이내、의진NSTEMI적환자분위NSTEMI조40례、심교통조56례、기타진단80례。 ROC곡선평고화태소급cTnI적진단성능。결과：（1）NSTEMI조화태소수평、cTnI양성솔명현고우기타각조（P＜0．05）。（2）화태소진단림계점시위10．85 pmol/L，령민도위90％，특이도위64％。cTnI진단림계점위0．05 ng/mL시，령민도위42．5％，특이도위94．1％。（3）화태소＜10．85 pmol/L연합cTnI＜0．05 ng/mL 대NSTEMI음성예측치위97．7％。결론：연합검측화태소급cTnI대NSTEMI적조기진단성능우우단독검측cTnI。
Objective To investigate the diagnostic accuracy and the clinical usefulness of the combination of troponin I (cTnI) and copeptin detected in patients with suspected non-ST elevation myocardial infarction. Methods 176 patients presenting to the emergency departments with chest chocking or chest pain within 6 hours and without ST elevation on a 12-lead electrocardiogram (ECG) were enrolled in this study. The level of copeptin and cTnI was measured. The diagnosis was adjudicated by 2 independent experts.The diagnostic performance of them was assessed using ROC analysis , and the sensitivity and specificity of them were inferred based on the positive rate of two cardiac markers. Results (1)The levels of copeptin and cTnI in NSTEMI patients were markedly higher than other groups (P<0.05).(2)The AUCs of copeptin and cTnI were 0.846 and 0.683, and the 95%CI of two markers were 0.786 ~ 0.906 and 0.577 ~ 0.789, respectively. (3)Using 10.85 pmol/L as cut off value,the sensitivity and specificity of copeptin were 90% and 64%,and the positive predictive value and the negative predictive valueof NSTEMI diagnose were 42.4% and 95.6%,respectively.Using 0.05 ng/mL as cut off value,the sensitivity and specificity of cTnI were 42.5% and 94.1%,the positive predictive value and the negative predictive value were 68%and 84.8% for diagnosis of NSTEMI. (4)The copeptin level over 10.85 pmol/L in combination with cTnI could be used to detect NSTEMI with higher sensitivity than that of copeptin or cTnI alone (95% vs 90% vs 42.5%). The negative predictive value of the combination of copeptin and cTnI was increased , compared to that of copeptin or cTnI alone (97.7% vs 95.6% vs 85.7%). Conclusions Determination of copeptin in addition to cTnI can improves diagnostic performance , especially early after chest pain onset. It seems to allow a rapid and reliable rule out of NSTEMI.
