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目的探讨高敏心肌肌钙蛋白T(hs-cTnT)、N末端脑钠肽前体(NT-proBNP)及高敏C-反应蛋白(hs-CRP)联合检测诊断AMI的临床价值。方法选取收治的AMI患者99例,其中STEMI 76例,NSTEMI 23例,另选无心血管、肺、肾等器质性疾病及急慢性炎症,ECG正常的体检健康者100例为对照组。比较2组人员入院即刻血清hs-cTnT、NT-proBNP及hs-CRP水平,通过绘制ROC曲线比较检测的准确度,并运用统计学方法探讨临床适用的hscTnT诊断临界值。结果AMI患者hs-cTnT水平为0.027~4.019 mg/L,均高于健康人群第99百分位值(0.014 mg/L),提示hs-cTnT阴性可排除AMI诊断;AMI患者hs-cTnT、NT-proBNP及hs-CRP水平均显著高于对照组(P<0.01)且STEMI患者相关指标水平显著高于NSTEMI患者(P<0.01);当以0.035 mg/L为临界值时诊断AMI灵敏度为94.7%,而特异度有较大提升,高至66.3%,此时反映试验真实性的Youden值最大,为0.610,提示以此为最佳临界值早期诊断AMI的临床价值最好;ROC曲线表明联合检测的曲线下面积为0.911,大于单纯hs-cTnT检测的曲线下面积0.887(P<0.05)及POCT检测的曲线下面积0.828(P<0.05)。结论 hs-cTnT作为心肌损伤特异性蛋白,对于AMI早期诊断具有良好的敏感性和特异性,联合NT-proBNP、hs-CRP等指标对于早期诊断AMI具有重要临床价值,值得临床推广应用。
Objective To investigate the clinical value of combined detection of hs-cTnT, NT-proBNP and hs-CRP in the diagnosis of AMI. Methods A total of 99 AMI patients were enrolled. Among them, 76 were STEMI and 23 were NSTEMI. There were no organic, cardiovascular, pulmonary and renal organic diseases, acute and chronic inflammation, and 100 healthy subjects with normal ECG were selected as the control group. Serum levels of hs-cTnT, NT-proBNP and hs-CRP were compared between the two groups immediately after admission. The accuracy of the detection was compared by drawing a ROC curve, and the clinical diagnostic threshold of hscTnT was statistically analyzed. Results The hs-cTnT levels in AMI patients ranged from 0.027 to 4.019 mg / L, both of which were higher than the 99th percentile (0.014 mg / L) of healthy people, suggesting that the negative hs-cTnT could exclude the diagnosis of AMI. The levels of -proBNP and hs-CRP in patients with STEMI were significantly higher than those in the control group (P <0.01), and the levels of related indicators in STEMI patients were significantly higher than those in patients with NSTEMI (P <0.01). The sensitivity of diagnosing AMI at the threshold of 0.035 mg / L was 94.7 %, While the specificity was greatly improved, up to 66.3%. The Youden value that reflects the authenticity of the test at this time is the largest, which is 0.610, suggesting that the best clinical value of early diagnosis of AMI is the best. The ROC curve shows that the joint The area under the curve was 0.911, which was larger than the area under the curve of hs-cTnT assay (P <0.05) and the area under the curve of POCT was 0.828 (P <0.05). Conclusion hs-cTnT, as a specific protein of myocardial injury, has good sensitivity and specificity for early diagnosis of AMI. Combined with NT-proBNP and hs-CRP, hs-cTnT has important clinical value in the early diagnosis of AMI and is worthy of clinical application.