增强型心肌肌钙蛋白I检测在急性冠状动脉综合征诊断中的应用

检验医学 ›› 2012, Vol. 27 ›› Issue (5): 345-348.

增强型心肌肌钙蛋白I检测在急性冠状动脉综合征诊断中的应用

张广慧¹,沈立松²

1.上海交通大学医学院附属新华医院检验科，上海 200092；2.上海交通大学医学院附属新华医院急诊科，上海 200092

收稿日期:2012-03-09 修回日期:2012-04-15 出版日期:2012-05-30 发布日期:2012-05-10
通讯作者: 沈立松，联系电话：021-25077070。
作者简介:张广慧，男，1969年生，学士，副主任技师，主要从事临床生物化学研究。
基金资助:
上海市科委择优委托项目（09DZ1907203）;上海市科委医学重点项目（10411950400）

Application of enhanced cardiac troponin I determination in clinical diagnosis of acute coronary syndrome

1.Department of Clinical Laboratory，Xinhua Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200092，China;2. Emergency Department, Xin hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

Received:2012-03-09 Revised:2012-04-15 Online:2012-05-30 Published:2012-05-10
Contact: Li-Song Shen

摘要/Abstract

摘要： 目的　观察增强型心肌肌钙蛋白I(cTnI)［即高敏cTnI（hs-cTnI）］在正常人群及急性冠状动脉综合征(ACS)人群中的分布情况并探讨其在ACS诊断中的应用。方法　选择胸痛12 h以内的ACS患者80例、同期入院稳定性心绞痛（SA）患者26例和正常对照者60名，检测外周血中hs-cTnI和上一代cTnI浓度，同时检测血常规、C反应蛋白（CRP）等指标。通过受试者工作曲线(ROC)评估hs-cTnI的诊断效能。结果　ACS组、SA组及正常对照组间hs-cTnI、cTnI差异均有统计学意义（P<0.05）。hs-cTnI的ROC曲线下面积（AUC）为0.986±0.014，高于cTnI的AUC（0.915±0.035）（P=0.034），而与hs-cTnI联合CRP、中性粒细胞百分率、中性粒细胞/淋巴细胞比值及白细胞计数的AUC（0.978±0.018）无差异（P>0.05）。当hs-cTnI 取0.02 ng/mL为最佳临界值，此时诊断ACS的效率最高。结论　hs-cTnI对早期ACS的诊断效率较上一代cTnI有所提高，但联合炎症指标没有提高其诊断价值。

关键词: 增强型心肌肌钙蛋白I, 急性冠状动脉综合征, 受试者工作特征曲线

Abstract: Objective　To observe the distribution of enhanced cardiac troponin I (cTnI)［high sensitive cTnI (hs-cTnI)］ in healthy subjects and patients with acute coronary syndrome (ACS), and investigate the application of hs-cTnI in the diagnosis of ACS. Methods　A total of 80 ACS patients who had chest pain onset within 12 h, 26 stable angina (SA) patients and 60 healthy controls were enrolled. The hs-cTnI，conventional cTnI，blood routine tests, C reactive protein (CRP) and other indices were determined among the groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnosis performance of hs-cTnI determination. Results　The concentrations of hs-cTnI had statistical significance among ACS, SA and control groups. The area under ROC curve (AUC) of hs-cTnI (0.986±0.014) was significantly higher than that of conventional cTnI (0.915±0.035, P=0.034). The AUC of hs-cTnI had no difference with those of hs-cTnI combined with CRP, neutropil granulocyte percentage/lymphocyte percentage ratio and white blood cell count (0.978±0.018,P>0.05). When the cut-off value was 0.02 ng/mL,the diagnosis performance was the best. Conclusions　Compared with the conventional cTnI, the hs-cTnI has diagnosis performance in early diagnosis of ACS. There is no diagnosis value in combined of inflammation indices.Objective　To observe the distribution of enhanced cardiac troponin I (cTnI)［high sensitive cTnI (hs-cTnI)］ in healthy subjects and patients with acute coronary syndrome (ACS), and investigate the application of hs-cTnI in the diagnosis of ACS. Methods　A total of 80 ACS patients who had chest pain onset within 12 h, 26 stable angina (SA) patients and 60 healthy controls were enrolled. The hs-cTnI，conventional cTnI，blood routine tests, C reactive protein (CRP) and other indices were determined among the groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnosis performance of hs-cTnI determination. Results　The concentrations of hs-cTnI had statistical significance among ACS, SA and control groups. The area under ROC curve (AUC) of hs-cTnI (0.986±0.014) was significantly higher than that of conventional cTnI (0.915±0.035, P=0.034). The AUC of hs-cTnI had no difference with those of hs-cTnI combined with CRP, neutropil granulocyte percentage/lymphocyte percentage ratio and white blood cell count (0.978±0.018,P>0.05). When the cut-off value was 0.02 ng/mL,the diagnosis performance was the best. Conclusions　Compared with the conventional cTnI, the hs-cTnI has diagnosis performance in early diagnosis of ACS. There is no diagnosis value in combined of inflammation indices.

Key words: Enhanced cardiac troponin I, Acute coronary syndrome, Receiver operating characteristic curve

张广慧;邓琳;费爱华;戴李华;陆一闻;沈立松. 增强型心肌肌钙蛋白I检测在急性冠状动脉综合征诊断中的应用[J]. 检验医学, 2012, 27(5): 345-348.

ZHANG Guang-Hui;DENG Lin;FEI Ai-Hua;DAI Li-Hua;LU Yi-Wen;SHEN Li-Song. Application of enhanced cardiac troponin I determination in clinical diagnosis of acute coronary syndrome[J]. , 2012, 27(5): 345-348.

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