摘要
目的探讨血清氨基末端B型钠尿肽原(NT-proBNP)、肌红蛋白(Myo)、心肌肌钙蛋白T(cTnT)对急性心肌梗死(AMI)及心力衰竭(HF)患者的临床诊断价值,研究3种标志物的特点,并根据其特点和患者病情选用合适的标志物。方法采用电化学发光免疫方法检测55例AMI患者治疗前、后以及105例HF患者、30名健康正常者的NT-proBNP、Myo、cTnT水平。按照美国纽约心脏病协会(NYHA)心功能分级标准将HF患者分为Ⅰ～Ⅳ级。比较各组的差异并作相关性分析,同时采用受试者工作特征(ROC)曲线评估3种标志物的灵敏度和特异性。结果 cTnT、Myo在AMI患者胸痛时间6 h内的诊断灵敏度分别为76.2%和93.9%,胸痛时间>6 h时的诊断灵敏度分别为90.5%和55.6%,AMI患者治疗后NT-proBNP、Myo、cTnT水平明显低于治疗前(P<0.05)。NYHAⅠ～Ⅳ级的HF患者间NT-proBNP、Myo、cTnT水平差异有统计学意义(P<0.05)。HF患者NT-proBNP水平与NYHA分级的相关性(rs=0.884)高于Myo(rs=0.652)和cTnT(rs=0.726)。结论在心功能分级以及AMI早期预警和早期诊断方面,NT-proBNP的灵敏度及相关性要明显优于Myo和cTnT,还常用于在呼吸困难人群中鉴别HF患者。Myo常作为急诊中排除急性心肌梗死的指标,早期诊断时要结合患者胸痛时间,观察有无再梗死或梗死再扩展。cTnT诊断AMI的特异性优于其他标志物,但要等到心肌梗死后才能做出判断。
Objective To study the clinical significance of the determination of 3 serum cardiac markers[N-terminal pro-B-type natriuretic peptide（NT-proBNP）,myoglobin（Myo） and cardiac troponin T（cTnT）] in the clinical diagnosis of acute myocardial infarction（AMI） and heart failure（HF）,and use them according to their characteristics and patients′ conditions.Methods The levels of the 3 markers of 55 patients with AMI before and after treatment,105 patients with HF and 30 healthy subjects were determined by electro-chemiluminescence immunoassay.According to the American New York Heart Association（NYHA） cardiac grading standards,HF patients were classified intoⅠ-Ⅳ grades.The differences and correlation were analyzed.The sensitivities and specificities of the 3 markers were evaluated by receiver operating characteristic（ROC） curve.Results The diagnostic sensitivities of cTnT and Myo in patients with AMI in 6h chest pain time were 76.2% and 93.9%,and 6h chest pain time were 90.5% and 55.6%.The levels of NT-proBNP,Myo and cTnT after the treatment in patients with AMI were lower than those before the treatment（P0.05）.Among the patients with HF atⅠ-Ⅳ grades,the levels of NT-proBNP,Myo and cTnT had statistical difference（P0.05）,and the correlation of NT-proBNP level with NYHA grade（rs=0.884） was higher than those of Myo（rs=0.652） and cTnT（rs=0.726）.Conclusions NT-proBNP is superior to Myo and cTnT for sensitivity and correlation in cardiac grading and the early warning and diagnosis of AMI.It can be used to distinguish HF patients in dyspnea ones.Myo is often used in emergency cases as exclusive index for AMI.For the early diagnosis,it should be observed the chest pain time whether there is infarction expanding or reinfarction.The specificity of cTnT for AMI diagnosis is superior to other markers,but can′t make judgment until myocardial infarction appearing.
出处
《检验医学》
CAS
北大核心
2011年第12期814-817,共4页
Laboratory Medicine
作者简介
作者简介：邱锡荣，男，1967年生，学士，副主任技师，主要从事医学免疫及分子生物学研究。
