急性心肌梗死患者高敏肌钙蛋白T水平与发病时间的关系研究

发布时间：2018-04-15 13:03

  本文选题：急性心肌梗死 + 心肌肌钙蛋白T　； 参考：《四川大学学报(医学版)》2017年05期

【摘要】：目的研究急性心肌梗死(AMI)患者高敏心肌肌钙蛋白T(hs-cTnT)水平与发病时间的关系。方法以2012年1月至2013年12月因胸痛于四川大学华西医院急诊科就诊的3 096例患者为研究对象,最终确诊为AMI患者1 082例,男性861例,女性221例,以胸痛发生至急诊就诊采血为发病时间,按hs-cTnT水平变化趋势将发病时间分为1h、1~2h、2~3h、3~4h、4~5h、5~6h、6~7h、7~8h、8~12h、12~16h、16~24h、24~48h、48~72h、72~96h、96~144h、≥144h共16组,分析不同发病时间段患者人数及hs-cTnT水平,计算各发病时间段患者hs-cTnT水平低于传统hs-cTnT阈值(14ng/L)的比例。通过研究各发病时间段胸痛患者hs-cTnT水平及ROC曲线,比较新确定的cut-off值(分段阈值)与传统阈值14ng/L在AMI诊断中的价值。结果 AMI发生5h内,血清hs-cTnT水平缓慢升高,5h以后升幅较大,48h左右到达峰值水平(2 000ng/L左右),48~96hhs-cTnT处于一个相对稳定期,随后迅速降低。1 082例AMI患者中,胸痛发生1h内就诊的患者hs-cTnT水平小于14ng/L的比例为53.3%,1~2h为19.1%,2~3h为9.4%,3~4h为6.1%,4~5h为2.8%。各时间段诊断AMI的cut-off值为:胸痛时间3h,hs-cTnT cut-off值为13.5ng/L时,敏感性为81.8%,特异性为80.1%;胸痛时间为3~6h,cut-off值为17.8ng/L时,敏感性为94.6%,特异性为84.3%;胸痛时间6~12h,cut-off值为30.0ng/L时,敏感性为95.9%,特异性为85.5%;胸痛时间≥12h,cut-off值为58ng/L时,敏感性92.7%,特异性为93.3%。4条ROC曲线的曲线下面积均0.5,均有诊断价值,且以≥12h组和6~12h组诊断价值最高,3~6h组诊断价值居中,3h组诊断价值最低。6~12h组分段阈值的敏感性与传统阈值相当,但特异性更高(P0.05);≥12h组的分段阈值牺牲了部分敏感性(P0.05),换取特异性的大幅提高(P0.05)。结论胸痛时间3h的hs-cTnT水平不足以诊断和排除AMI,应至少动态监测5h。胸痛时间≥6h者应使用较传统阈值更高的阈值以减少误诊。
[Abstract]:Objective to study the relationship between the level of cardiac troponin TnT and onset time in patients with acute myocardial infarction (AMI).Methods from January 2012 to December 2013, 3 096 patients with chest pain in the emergency department of Huaxi Hospital, Sichuan University were selected as subjects. 1,082 patients with AMI were diagnosed, including 861 males and 221 females.According to the change trend of hs-cTnT level, the onset time of chest pain was divided into 1 hour, 1h, 1h, 2h, 2h, 3h, 3h, 4h, 4h, 5h, 5h, 6h, 7h, 8h, 8h, 12h, 12h, 1624h, 2448h, 48h, 72h, 72h, 96h, 144h, respectively. The number of patients and the level of hs-cTnT were analyzed.The ratio of hs-cTnT level lower than the traditional hs-cTnT threshold of 14 ng / L was calculated.By studying the hs-cTnT level and ROC curve of patients with chest pain at different time stages, the value of newly determined cut-off value (segmental threshold) and traditional threshold 14ng/L in the diagnosis of AMI was compared.Results within 5 hours after the onset of AMI, the level of serum hs-cTnT increased slowly and reached the peak level at about 48 h after the onset of AMI. The peak level was about 2 000ng/L and the level of cTnT was at a relatively stable stage, and then decreased rapidly in 1. 082 cases of AMI.The hs-cTnT level of the patients with chest pain within 1 hour was less than that of 14ng/L. The ratio of 53.3 hours and 1h was 19.1h, 2h, 3h, 9.4h, 6.1h and 2.8h, respectively.The cut-off values of AMI in each time period were as follows: when the time of chest pain was 3hh, hs-cTnT cut-off was 13.5ng/L, the sensitivity was 81.8 and the specificity was 80.1. When the time of chest pain was 3 ~ 6 hcut-off, the sensitivity was 94.6 and the specificity was 84.3. When the time of chest pain was 612hcut-off, the sensitivity was 94.6 and the specificity was 84.3. When the time of chest pain was 612hcut-off was 30.0ng/L,The sensitivity was 95.9 and the specificity was 85.5. When the chest pain time 鈮，

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