[1]冯晓敏,刘玉薇,苏静静,等.高敏肌钙蛋白T对不同风险分层非ST段抬高型心梗的诊断价值分析[J].现代检验医学杂志,2018,33(03):141-143,147.[doi:10.3969/j.issn.1671-7414.2018.03.036]
　FENG Xiao-min,LIU Yu-wei,SU Jing-jing,et al.High-Sensitivity Troponin T for the Diagnosis of Non-ST Elevation Myocardial Infarction with Different Risk Stratification[J].Journal of Modern Laboratory Medicine,2018,33(03):141-143,147.[doi:10.3969/j.issn.1671-7414.2018.03.036]
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高敏肌钙蛋白T对不同风险分层非ST段抬高型心梗的诊断价值分析()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第33卷
期数:
2018年03期
页码:
141-143,147
栏目:
检验与临床
出版日期:
2018-07-17

文章信息/Info

Title:
High-Sensitivity Troponin T for the Diagnosis of Non-ST Elevation Myocardial Infarction with Different Risk Stratification
文章编号:
1671-7414(2018)03-141-04
作者:
冯晓敏1; 刘玉薇1; 苏静静1; 赵 雅1; 万 楠2
1.大连医科大学沈阳军区总医院研究生培养基地, 辽宁大连 116044; 2.沈阳军区总医院检验科,沈阳 110016
Author(s):
FENG Xiao-min1; LIU Yu-wei1; SU Jing-jing1; ZHAO Ya1; WAN Nan2
1.Postgraduate Training Base of Shenyang Military Region General Hospital of Dalian Medical University,Liaoning Dalian 116044 China; 2.Departmentof Clinical Laboratory,the General Hospital of Shenyang Military,Shenyang 110016,China
关键词:
高敏肌钙蛋白T;  GRACE危险评分;  非ST段抬高型心肌梗死
分类号:
R541; R446.112
DOI:
10.3969/j.issn.1671-7414.2018.03.036
文献标志码:
A
摘要:
目的 探讨高敏肌钙蛋白T(hs-cTnT)对不同风险分层非ST段抬高型心肌梗死(NSTEMI)的诊断价值。方法 选取2017年10～12月就诊于沈阳军区总医院急诊的胸痛患者381例(除外ST段抬高型心肌梗死和心律失常患者),根据全球急性冠状动脉事件注册(GRACE)危险评分将患者分为低、中和高危三组,采用电化学发光法检测患者血浆hs-cTnT水平,应用方差分析和受试者工作特征曲线(ROC曲线)判断hs-cTnT的诊断价值。结果 低、中和高危组患者人数分别为239例、93例和49例; NSTEMI患病率分别为25.1%,41.9%和76.0%。低危组曲线下面积0.89(95%CI:0.84～0.93),特异度94%,敏感度59%,阴性预测值88%,阳性预测值73%。中危组曲线下面积0.92(95%CI:0.84～0.97),特异度83%,敏感度87%,阴性预测值90%,阳性预测值79%。高危组曲线下面积0.95(95%CI:0.85～0.99),特异度90%,敏感度90%,阴性预测值75%,阳性预测值97%。高危组血浆hs-cTnT浓度(0.96±1.5 ng/L)明显高于中危组(0.41±0.75 ng/L)和低危组(0.16±0.56 ng/L),差异均有统计学意义(F=45.376,P<0.05)。3个组NSTEMI患者血浆hs-cTnT浓度均高于其他诊断患者, 差异有统计学意义(P<0.05)。结论 hs-cTnT可以作为高风险NSTEMI早期诊断的指标,但对中、低危组诊断价值略低。
Abstract:
Abstract:Objective To investigate the value of high-sensitivity cardiac troponin T(hs-cTnT)to the diagnosis of non-ST elevation myocardial infarction(NSTEMI)in patients with different risk stratification.Methods A total of 381 acute chest discomfort patients(excluding ST-elevation myocardial infarction and arrhythmia)who had been seen inShenyang Military Region General Hospital emergency department from Oct,2017 toDec,2017 were enrolled.According to the global GRACE risk score,the patientswere divided into low,moderate and high risk groups.The plasma levels of hs-cTnT were detected by electrochemiluminescence method.Analysis of variance andreceiver operating characteristic curve(ROC curve)were used to determine the diagnostic value of hs-cTnT.Results The number of patients in the low,moderate and high risk groups was 239,93 and 49,respectively.The prevalence of NSTEMI was 25.1%,41.9%,and 76.0%,respectively.The area under the ROC curve in low risk group was 0.89(95% CI:0.84～0.93),specificity was 94%,sensitivity was 59%,negative predictive value was 88%,and positivepredictive value was 73%.The area under the ROC curve in moderate risk group was 0.92(95% CI:0.84～0.97),specificity was 83%,sensitivity was 87%,negative predictive value was 90%,and positive predictive value was 79%.The area under the ROC curve in high risk group curve was 0.95(95% CI:0.85～0.99),specificity was 90%,sensitivity was 90%,negative predictive value was 75%,and positive predictive value was 97%.The level of plasma hs-cTnT was significantlyhigher in high-risk group than that in low-risk and middle-risk group(F=45.376,P<0.05).In all three groups,in patients with high-risk group,concentrations of hs-cTnT were significantly higher in patients with NSTEMI as compared with patients with other diagnoses(all P<0.05).ConclusionHs-cTnT can be used as an indicator of early diagnosis of high-risk NSTEMI,but the diagnostic value of the low-risk group is slightly lower.

参考文献/References:

[1] Mueller-Hennessen M,Mueller C,Giannitsis E,et al.Serial sampling of high-sensitivity cardiac troponin T may not be required for predictionof acute myocardial infarction diagnosis in chest pain patients with highly abnormal concentrations at presentation[J].Clinical Chemistry,2017,63(2)2:542-551.
[2] 中华医学会心血管病学分会.中华心血管病杂志编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304. Chinese Society of Cardiology Chinese Medical Association,Editiorial Board of Chinese Journal of Cardiology.Guideline for diagosis and treatment of patients with unstable angina and non-ST segment elevation myocardial infarction(no abstract)[J].Chinese Journal of Cardiology,2007,35(4):295-304.
[3] Mendis S,Thygesen K,Kuulasmaa K,et al.World Health Orangization definition of myocardial infarction 2008-09 revision[J].Int Epidemiol,2011,40(1):139-146.
[4] 彭继仁,葛 萱.联合检测和肽素与高敏心肌肌钙蛋白T对急性心肌梗死早期诊断的价值[J].中国循环杂志,2014,29(10):772-775. Peng JR,Ge X.Diagnostic value of combined examination of copeptinand high sensitivity cardiac troponin T in patients at early stage of acute myocardial infarction[J].Chinese Circulation Journal,2014,29(10):772-775.
[5] Keller T,Zeller T,Peetz D,et al.Sensitive troponin I assay in early diagnosis of acute myocardial infarction[J].N Engl J Med,2009,361(9):868-877.
[6] 喻红波,刘 阳,罗俊卿,等.髓过氧化物酶在非ST段抬高急性冠状动脉综合征诊断和预后中的临床应用[J].现代检验医学杂志,2015,30(3):77-79. Yu HB,Liu Y,Luo JQ,et al.Clinical application of myeloperoxidasein diagnosis and prognosis of non-ST elevation acuten cornary syndromes[J].Journal of Modern Laboratory Medicine,2015,30(3):77-79.
[7] Apple FS,Sandova lY,Jaffe AS,et al.Cardiac troponin assays:guide tounderstanding analytical characteristics and their impact on clinical care[J].Clin Chem,2017,63(1):73-81.
[8] 李广权,黄华兰,贺 勇,等.高敏肌钙蛋白T检测在老年急性心肌梗死患者诊断中的价值[J].国际检验医学杂志,2015,36(4):451-453. Li GQ,Huang HL,He Y,et al.The significance of high-sensitivitytroponin T measurement in the diagnosis of elderly patients with acute myocardial infarction[J].International Journal of Laboratory Medicine,2015,36(4):451-453.

备注/Memo

备注/Memo:
基金项目:循环MicroRNA作为新型冠心病血浆标志物的相关研究(201602792)。 作者简介:冯晓敏(1992-),女,硕士研究生,主要从事循环microRNA作为新型冠心病血浆标志物的相关研究,E-mail:953483976@qq.com。 通讯作者:万 楠(1978-),博士研究生,主要从事循环microRNA作为新型冠心病血浆标志物的相关研究,E-mail:wannan@outlook.com。
更新日期/Last Update: 2018-04-16