高敏肌钙蛋白I在急性心肌梗死1小时快速分诊中的应用价值

发布时间：2018-03-12 12:41

本文选题：高敏肌钙蛋白I　切入点：急性心肌梗死　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨使用高敏肌钙蛋白I(high sensitivity cardiac troponin I,hs-cTnI)对急性心肌梗死(acute myocardial infraction,AMI)患者1小时快速分诊的有效性和可行性,为hs-cTnI的临床应用提供理论和实践依据。方法根据一定的入选和排除标准,选取105例急诊科收治的以急性胸痛为首发症状的疑似AMI患者,采用循环增强荧光免疫检测法测定入院即刻(0小时)和入院1小时患者血浆中hs-cTnI浓度。同时选取220例同期健康体检者作为正常参考人群,测定血浆中hs-cTnI浓度,根据第99百分位数值确定hs-cTnI的cut-off值。结果hs-cTnI的cut-off值为10.67pg/m L。疑似AMI患者,入院1小时hs-cTnI浓度明显高于正常参考人群和入院0小时(H=258.08,U=79.05、232.45,p0.01)。入院0小时hs-cTnI浓度明显高于正常参考人群(H=258.08,U=20.06,p0.01)。最终确诊为AMI的患者,入院0小时hs-cTnI浓度明显高于其他临床诊断者。AMI患病率随入院0小时、1小时hs-cTnI浓度值的增大而增高。使用hs-cTnI 1小时分诊方法,疑似AMI患者中,被纳入排除组、入选组和观察组的比例分别为67%、19%、14%。排除组中,AMI的灵敏度和阴性预测价值分别为90.9%、98.3%;入选组中,AMI的特异度和阳性预测值分别为91.7%、87.5%。1小时和0小时分诊方法ROC曲线下面积(AUCROC)分别为0.918、0.831,前者诊断价值更高(Z=2.171,p0.05)。排除组、观察组和入选组30天死亡率分别为0%、0%、5%;6个月死亡率分别为1.4%、6%、10%。结论疑似AMI患者,使用hs-cTnI 1小时快速分诊方法,并结合心电图等其他临床资料,可实现86%的急性胸痛患者在1小时内被安全的排除或准确的诊断。这对于缩短AMI诊断时间,降低死亡率和误诊率,减轻医疗成本和负担具有重要的意义。
[Abstract]:Objective to investigate the effectiveness and feasibility of using Gao Min high sensitivity cardiac troponin Ihs-cTnI in the diagnosis of acute myocardial infract AMI in patients with acute myocardial infarction (AMI), and to provide theoretical and practical basis for the clinical application of hs-cTnI. A total of 105 suspected AMI patients with acute chest pain were selected. Plasma hs-cTnI levels were measured by circulating enhanced fluorescence immunoassay (hs-cTnI) and 1 hour after admission. The plasma hs-cTnI concentrations were measured in 220 healthy controls. The cut-off value of hs-cTnI was determined according to the 99th percentile value. Results the cut-off value of hs-cTnI was 10.67 PG / mL. The concentration of hs-cTnI at one hour after admission was significantly higher than that in the normal reference group and in the 0 hour group. The concentration of hs-cTnI was significantly higher than that in the normal reference group at 0 hours after admission to the hospital, and the concentration of hs-cTnI was significantly higher than that in the normal reference group. The final diagnosis of AMI was found in the patients with AMI. The prevalence of hs-cTnI at 0 h after admission was significantly higher than that of other clinical diagnostics. The prevalence rate of hs-cTnI increased with the increase of hs-cTnI concentration at 0 h and 1 h after admission. Using hs-cTnI 1 hour fractionation, suspected AMI patients were included in the excluded group. The sensitivity and negative predictive value of AMI in exclusion group were 90.9 and 98.3, respectively, and the specificity and positive predictive value of AMI in selected group were 91.7 and 87.5.1 hours, respectively. The diagnostic value of the former was higher than that of the control group. In the observation group and the inclusion group, the 30-day mortality rate was 0 and the death rate in 6 months was 1.40.Conclusion in the suspected AMI patients, the method of hs-cTnI 1 hour rapid diagnosis was used, and other clinical data, such as electrocardiogram, were used. 86% of the patients with acute chest pain can be safely excluded or accurately diagnosed within one hour, which is of great significance for shortening the time of AMI diagnosis, reducing the mortality rate and misdiagnosis rate, and reducing the cost and burden of medical treatment.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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