中国实验诊断学
中國實驗診斷學
중국실험진단학
CHINESE JOURNAL OF LABORATORY DIAGNOSIS
2014年
11期
1819-1821
,共3页
钱洲楠%张浩%任国庆%孙文文%尹江宁
錢洲楠%張浩%任國慶%孫文文%尹江寧
전주남%장호%임국경%손문문%윤강저
和肽素%心肌梗死%肌钙蛋白 I%心绞痛%早期诊断
和肽素%心肌梗死%肌鈣蛋白 I%心絞痛%早期診斷
화태소%심기경사%기개단백 I%심교통%조기진단
copeptin%Myocardial infarction%cTnI%Angina%Early diagnosis
目的：探讨和肽素及肌钙蛋白I（cTnI）对急性心肌梗死的早期诊断价值。方法入选136例因胸闷或胸痛就诊、发病在6h以内且疑诊冠心病的患者，入院即刻抽取静脉血检测和肽素（copeptin）及 cTnI，诊断性能用 ROC曲线及 AUC表示，并根据 copeptin、cTnI的阳性率，计算出对急性心肌梗死诊断的灵敏度、特异度等。结果①AMI组患者血浆 copeptin水平及 cTnI阳性率显著高于其它三组，差异均有统计学意义（P＜0．05）；②根据 ROC曲线分析，和肽素及 cTnI的 AUC 分别为0．821、0．698；95％可信区间分别为0．753-0．889、0．576-0．820。③copeptin分界值为10．75 pmol／l时灵敏度为83．3％，特异度为70．8％，阳性预测值为43．6％，阴性预测值为92．6％。本研究所用 cTnI试剂盒以0．05 ng／mL为分界值，其灵敏度为43．3％，特异度为96．2％，阳性预测值为76．5％，阴性预测值为85.7％。④较单独使用某一指标，联合检测可提高诊断 AMI的敏感性（96．7％ vs 83．3％ vs 43．3％，P＜0．05）。Copeptin＜10．75 pmol／L联合 cTnI＜0．05 ng／mL对于早期排除 AMI价值较大，其阴性预测值达98．9％。结论和肽素及 cT-nI对 AMI的早期诊断性能优于单一检测 cTnI。对于急诊胸痛患者，联合检测 copeptin及 cTnI有助于快速排除急性心梗。
目的：探討和肽素及肌鈣蛋白I（cTnI）對急性心肌梗死的早期診斷價值。方法入選136例因胸悶或胸痛就診、髮病在6h以內且疑診冠心病的患者，入院即刻抽取靜脈血檢測和肽素（copeptin）及 cTnI，診斷性能用 ROC麯線及 AUC錶示，併根據 copeptin、cTnI的暘性率，計算齣對急性心肌梗死診斷的靈敏度、特異度等。結果①AMI組患者血漿 copeptin水平及 cTnI暘性率顯著高于其它三組，差異均有統計學意義（P＜0．05）；②根據 ROC麯線分析，和肽素及 cTnI的 AUC 分彆為0．821、0．698；95％可信區間分彆為0．753-0．889、0．576-0．820。③copeptin分界值為10．75 pmol／l時靈敏度為83．3％，特異度為70．8％，暘性預測值為43．6％，陰性預測值為92．6％。本研究所用 cTnI試劑盒以0．05 ng／mL為分界值，其靈敏度為43．3％，特異度為96．2％，暘性預測值為76．5％，陰性預測值為85.7％。④較單獨使用某一指標，聯閤檢測可提高診斷 AMI的敏感性（96．7％ vs 83．3％ vs 43．3％，P＜0．05）。Copeptin＜10．75 pmol／L聯閤 cTnI＜0．05 ng／mL對于早期排除 AMI價值較大，其陰性預測值達98．9％。結論和肽素及 cT-nI對 AMI的早期診斷性能優于單一檢測 cTnI。對于急診胸痛患者，聯閤檢測 copeptin及 cTnI有助于快速排除急性心梗。
목적：탐토화태소급기개단백I（cTnI）대급성심기경사적조기진단개치。방법입선136례인흉민혹흉통취진、발병재6h이내차의진관심병적환자，입원즉각추취정맥혈검측화태소（copeptin）급 cTnI，진단성능용 ROC곡선급 AUC표시，병근거 copeptin、cTnI적양성솔，계산출대급성심기경사진단적령민도、특이도등。결과①AMI조환자혈장 copeptin수평급 cTnI양성솔현저고우기타삼조，차이균유통계학의의（P＜0．05）；②근거 ROC곡선분석，화태소급 cTnI적 AUC 분별위0．821、0．698；95％가신구간분별위0．753-0．889、0．576-0．820。③copeptin분계치위10．75 pmol／l시령민도위83．3％，특이도위70．8％，양성예측치위43．6％，음성예측치위92．6％。본연구소용 cTnI시제합이0．05 ng／mL위분계치，기령민도위43．3％，특이도위96．2％，양성예측치위76．5％，음성예측치위85.7％。④교단독사용모일지표，연합검측가제고진단 AMI적민감성（96．7％ vs 83．3％ vs 43．3％，P＜0．05）。Copeptin＜10．75 pmol／L연합 cTnI＜0．05 ng／mL대우조기배제 AMI개치교대，기음성예측치체98．9％。결론화태소급 cT-nI대 AMI적조기진단성능우우단일검측 cTnI。대우급진흉통환자，연합검측 copeptin급 cTnI유조우쾌속배제급성심경。
Objective To assess the value of copeptin and cTnI for rule out of acute myocardial infarction(AMI). Methods One hundred and thirty-six patients presenting into emergency departments with chest chocking or chest pain within 6 hours were enrolled.copeptin and cTnI was measured.The diagnosis was adj udicated by 2 independent experts using all available data.The blood samples were tested for copeptin and cTnI at the same time.The diagnostic perform-ance of them was assessed using ROC analysis.The sensitivity and specificity were inferred based on the positive rate of two cardiac markers.Results ①The levels of copeptin and cTnI in AMI patients were obviously higher than other groups(P<0.05);②The AUCs of copeptin and cTnI were 0.821,0.698;and the 95%CI of two markers were 0.753-0.889、0.576-0.820③Using10.75pmol/L as cut off value,the sensitivity and specificity of copeptin were 83.3%and70.8%,the positive predictive value and negative predictive value were 43.6% and 92.6% to diagnose AMI.Using 0.05ng/mL as cut off value,the sensitivity and specificity of cTnI were 43.3% and 96.2%,the positive predictive value and negative predictive value were 76.5%and 85.7% to diagnose AMI.④A copeptin level≥10.75pmol/L pmol/L in combination with cTnI detected AMI with higher sensitivity than for copeptin or cTnI alone(96.7% vs 83.3% vs 43.3%,P<0.05).The negative predictive value of the combination copeptin+cTnI was increased,compared to that of cTnI alone (98.9% vs 85.7%,P<0.05).Conclusion Determination of copeptin in addition to troponin can improves diagnostic performance,especially early after chest pain onset.They can provides a remarkable negative predictive value and allow a rapid and reliable rule out of the diagnosis of AMI.
