摘要
目的探讨缺血修饰清蛋白（IMA）、N末端脑钠肽前体（NT-proBNP）及超敏肌钙蛋白I（TnI-Ultra）联合检测对急性冠状动脉综合征（ACS）的临床诊断价值。方法收集该院健康对照组30例、非缺血性胸痛组（NICP）46例、不稳定型心绞痛（UA）组57例、非ST段抬高心肌梗死（NSTEMI）组21例和ST段抬高心肌梗死（STEMI）组19例。检测所有研究对象的血清IMA、NT-proBNP和TnI-Ultra水平并进行比较;记录胸痛发作时间,分析ACS患者胸痛小于3h内与3-6h间各项指标的变化;计算3项指标单独检测及其联合应用对ACS诊断的敏感度、特异度、阳性预测价值（PPV）、阴性预测值（NPV）和准确性。结果NSTEMI组、STEMI组患者血清IMA、NT-proBNP、TnI-Ultra水平均高于NICP组和健康对照组,差异有统计学意义（P〈0.05）;ACS患者血清IMA和NT-proBNP均值水平在胸痛小于3h组和胸痛3-6h组均高于健康对照组,差异有统计学意义（P〈0.05）;3项指标联合应用诊断ACS的敏感度、NPV和准确性均高于任何一项单独检测。结论血清IMA可作为心肌缺血标志物,IMA、NT-proBNP、TnI-Ultra水平变化可反映ACS发病的不同阶段,通过联合检测3项指标可提高ACS诊断的敏感度和准确性,对ACS的早期诊断及预后评估有一定的临床价值。
Objective To investigate the diagnosis value of IMA,NT-proBNP and TnI-Ultra in ACS.Methods Thirty healthy people as the control group,then non-ischemic chest pain group 46 cases,unstable angina 57 cases,non-ST elevation myocardial infarction group 21 cases and ST-elevation myocardial infarction group 19 cases were selected.Levels of IMA,NT-proBNP and TnI-Ultra were measured,three indicator levels of each group and within 3hours group and 3-6hours group in ACS patients were analyzed and compared statistically.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy to the diagnosis of ACS were calculated by separated detection and combined application.Results The levels of IMA,NT-proBNP,TnI-Ultra in the NSTEMI group and the STEMI group were higher than the NICP group and the control group.The levels of IMA and NT-proBNP in ACS groups within 3hour and between 3to 6hour were significantly higher than the control group（P〈0.05）.The sensitivity,negative predictive value,and accuracy of the combination of serum IMA,NT-proBNP and TnI-Ultra to diagnose ACS were higher than any individual indicator.Conclusion The serum IMA can be used as an indicator of ACS in early myocardial ischemia,serum IMA in combination with NT-proBNP and TnI-Ultra may reflect the different stages of the onset of ACS and could improve the sensitivity and accuracy,which have an important clinical value in the early diagnosis and prognosis evaluation.
出处
《检验医学与临床》
CAS
2016年第3期325-327,331,共4页
Laboratory Medicine and Clinic
基金
重庆市科委基金资助项目(cstc2014jcyjA1633)
