超敏肌钙蛋白I在急诊胸痛患者急性心肌梗死早期预测中的价值

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摘要目的探讨超敏肌钙蛋白I（hs-cTnI）的动态变化，明确不同时间点的诊断截点及变化范围，为早期诊断急性心肌梗死（AMI）提供有效预测工具。方法纳入2016年11月～2017年12月就诊于上海中医药大学附属普陀医院的急诊胸痛患者142例，最终诊断为AMI患者75例，不稳定性心绞痛（UA）患者37例，并选择同期健康体检者30名作为健康对照组。采用直接化学发光免疫分析法检测三组患者入院即刻（T0）、入院3 h（T3）的血清hs-cTnI值，并计算T3-T0 hs-cTnI的绝对变化值及其hs-cTnI的变化斜率（△hs-cTnI）。根据受试者工作特征曲线（ROC）及Youden指数判断不同时间点的最佳诊断截点及最佳变化范围。结果 ①急诊胸痛患者胸痛症状明显改善，（T0）hs-cTnI≥0.04 ng/mL，（T3）hs-cTnI≥0.48 ng/mL [AUC：0.994，最佳截断值：0.48 ng/mL]或T3-T0 hs-cTnI绝对变化值≥0.45 ng/mL [AUC：0.952，最佳截断值：0.45 ng/mL]，诊断AMI价值较大；②如果胸痛症状持续不能改善，T3-T0 hs-cTnI绝对变化值≥1.001 ng/mL [AUC：0.945，最佳截断值：1.001 ng/mL]，诊断AMI价值较大；③而对于只有一过性胸痛症状发生，（T0）hs-cTnI≥0.05 ng/mL [AUC：0.483，最佳截断值：0.05 ng/mL]，随访3 h hs-cTnI绝对变化值下降≥0.015 ng/mL [AUC：0.686，最佳截断值：-0.015 ng/mL]，诊断UA价值大。④AMI组△hs-cTnI较UA组明显升高（P < 0.01）。结论单独使用（T0）及（T3）hs-cTnI不能有效诊断AMI，使用hs-cTnI单点诊断数值（T0或T3）结合hs-cTnI绝对变化值诊断AMI有效性较高。

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	韩敏沈清邵周俊孙燕妮郭瑞敏▲

关键词 ：胸痛, 急性心肌梗死, 超敏肌钙蛋白I, 诊断截点

Abstract：Objective To provide an effective predictive tool in patients with acute myocardial infarction (AMI) via exploring the dynamic changes of the high-sensitive troponin I (hs-cTnI) at different time points, and to identify the range of changes at different diagnostic cut-off point. Methods A total of 142 chest paining patients in Putuo Hospital Affiliated to Shanghai Traditional Chinese Medicine University were collected from November 2016 to December 2017. Seventy-five AMI patients and 37 unstable angina (UA) patients were finally diagnosed. Thirty healthy subjects who underwent physical examination in the same period were selected as the healthy control group. Serum levels of hs-cTnI were measured at admission to hospital (T0) and 3 hours later (T3) by direct chemiluminescence immunoassay. The absolute change value of hs-cTnI and slop coefficient of hs-cTnI (△hs-cTnI) were calculated based on the two time points. The receiver operating characteristic curve (ROC) and Youden index were determined to provide the best diagnostic cut-off point and the optimal ranges. Results ① If chest pain symptoms were improved significantly, (T0) hs-cTnI≥0.04 ng/mL, (T3) hs-cTnI≥0.48 ng/mL [AUC: 0.994, the cutoff: 0.48 ng/mL] or T3-T0 hs-cTnI absolute changes≥0.45 ng/mL [AUC: 0.952, the cutoff: 0.45 ng/mL] were valuable to diagnosis of AMI. ② If chest pain symptoms were persisted, the absolute changes T3-T0 hs-cTnI≥1.001 ng/mL [AUC: 0.945, the cutoff: 1.001 ng/mL] were valuable to diagnosis of AMI. ③ If chest pain transiently occurred, (T0) hs-cTnI≥0.05 ng/mL [AUC: 0.483, the cutoff: 0.05 ng/mL], and the absolute changes hs-cTnI falling≥0.015 ng/mL [AUC: 0.686, the cutoff: -0.015 ng/mL] were valuable to diagnosis of UA. ④△hs-cTnI in the AMI group increased significantly compared with the UA group (P < 0.01). Conclusion AMI can not be effectively diagnosed by hs-cTnI of T0 or T3. The △hs-cTnI single point diagnostic values (T0 or T3) combined with the absolute changes of hs-cTnI are valuable for AMI diagnosis.

Key words： Chest pain Acute myocardial infarction High-sensitive troponin I Diagnostic cut-off point

基金资助:上海中医药大学预算内项目（自然科学类）（201 6YSN59）。

通讯作者: ▲通讯作者

引用本文:

韩敏沈清邵周俊孙燕妮郭瑞敏▲. 超敏肌钙蛋白I在急诊胸痛患者急性心肌梗死早期预测中的价值[J]. 中国医药导报, 2019, 16(3): 16-21.
HAN Min SHEN Qing SHAO Zhoujun SUN Yanni GUO Ruimin▲. The predictive value of high-sensitive troponin I in acute myocardial infarction of patients with emergency chest pain. 中国医药导报, 2019, 16(3): 16-21.

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