摘要
目的探讨CK、CK-MB与CK-MB/CK在诊断急性心肌梗死(AMI)中的临界值。方法对2006年9月至2008年4月在苏州大学附属第一医院住院的612例次急性心肌梗死(AMI)患者和463例非急性心肌梗死患者,使用OLYMPUSAU5421生化分析仪,和日本第一化学株式会社生产的CK检测试剂对心肌酶(CK)及心肌酶同工酶(CK-MB)进行检测。采用回归分析研究CK、CK-MB以及CK-MB/CK的比值在诊断急性心肌梗死中的价值,并使用接受者工作特征曲线(ROC)分析CK、CK-MB两个指标在诊断急性心肌梗死的临界值。结果回归分析CK的预计值是0.0276,标准误为0.00189,卡方值为213.3050,P<0.0001,标化预计值为21.0765;CK-MB的预计值是-4.6792,标准误为0.3298,卡方值为201.3519,P<0.0001,标化预计值为-227.5;CK-MB/CK的预计值是0.0484,标准误为0.3282,卡方值为0.0217,P值0.8828,标化预计值为0.00534。ROC分析CK曲线下面积(AUC)为0.811,95%可信区间0.786～0.834,Z值为22.595,P值为0.0001,界值为148,敏感性为86.58,敏感性的95%的可信区间为83.1～89.6,特异性为64.38,特异性的95%的可信区间为60.4～68.2,阳性似然比为2.43,阳性似然比的95%的可信区间为2.3～2.6,阴性似然比为0.21,阴性似然比的95%的可信区间为0.2～0.3;CK-MBAUC为0.840,95%可信区间为0.816～0.861,Z值为26.578,P值为0.0001,界值为29.8;敏感性为76.89,敏感性的95%的可信区间为72.8～80.7,特异性为74.18,特异性的95%的可信区间为70.5～77.6,阳性似然比为2.98,阳性似然比的95%的可信区间为2.8～3.2,阴性似然比为0.31,阴性似然比的95%的可信区间为0.3～0.4;CK-MB/CK比值AUC为0.533,95%可信区间0.503～0.563,Z值为1.857,P值为0.0633。ROC分析结果两两相比为CK-MB诊断效能优于CK,有显著性差异。而CK-MB/CK比值无统计学意义。结论当CK>148,和(或)CK-MB>29.8时,诊断急性心肌梗死的敏感性和特异性最好,而CK-MB/CK的比值缺乏统计学意义。
Objective To re-explore the cut-off values of CK,CK-MB and CK-MB/CK in early diagnosis of acute myocardial infarction （AMI）.Methods One thousand and seventy-five consecutive patients underwent creatine kinase and creatine kinase-MB test from Sep.2006 to Apr.2008 in the First Affiliated Hospital of Soochow Uuniversity.463 of them were non-acute myocardial infarction,and 612 of acute myocardial infarction.The logistic procedure analysis the diagnostic power of CK、CK-MB and CK-MB/CK in acute myocardial infarction.Receiver operating characteristic （ROC） curve analysis studied the diagnostic cut-off of the CK and CK-MB these two indices.Results The logistic procedure analysis demonstrated that the estimate of CK was 0.0276,standard error was 0.00189,Chi-Square was 213.3050,P was 0.0001,standardize estimate was 21.0765,Sensitivity was 86.58,95%CI was 83.1~89.6,specificity was 64.38,95%CI was 60.4~68.2,＋LR was 2.43,95%CI was 2.3~2.6,-LR was 0.21,95%CI 0.2~0.3;the estimate of CK-MB was-4.6792,standard error was 0.3298,Chi-Square was 201.3519,P was 0.0001,standardize estimate was-227.5,Sensitivity was 76.89,95% CI was 72.8 ~80.7,specificity was 74.18,95%CI was 70.5~77.6,＋LR was 2.98,95%CI was 2.8~3.2,-LR was 0.31,95%CI 0.3~0.4;the estimate of CK-MB/CK was 0.0484,standard error was 0.3282,Chi-Square was 0.0217,P was 0.8828,standardize estimate was 0.00534;ROC demonstrated that the area under the curve （AUC） of the CK was 0.811,95% confidence interval （CI） 0.786~0.834,Z was 22.595,P was 0.0001,the cut-off value was 148;the AUC of CK-MB was 0.840,95%CI was 0.816~0.861,Z was 26.578,P was 0.0001,the cut-off value was 29.8.the AUC of the ratio of CK-MB/CK was 0.533,95% CI 0.503~0.563,Z was 1.857,P was 0.0633.ROC also demonstrated that the diagnostic power of CK-MB was better than the one of the ratio of CK,with significant differ ences.However,the ratio of CKMB/CK had no statistical significance.Conclusion While CK148 and （or） CK-MB 29.8,the sensitivity and the specificity with diagnosing AMI are the best.However the CK-MB/CK’s value is absent of statistical significance.
出处
《中国现代医药杂志》
2010年第8期20-23,共4页
Modern Medicine Journal of China
关键词
CK
CK-MB
CK-MB/CK
AMI
Creatine kinase（CK） Creatine kinase-MB（CK-MB） CK-MB/CK Acute myocardial infarction（AMI）
作者简介
通讯作者：贺永明，E-mail：heyongming@suda．edu．cn.
