心肌标志物联合检测在急性心肌梗死早期诊断中的应用

摘要

Objective To investigate the combined detection of the high sensitive C reactive protein (hs-CRP), cardiac troponin I (cTnI) and creatine kinase isoenzyme (CK-MB) applied in the detection in the early diagnosis of acute myocardial infarction .Methods One hundred and six patients with myocardial infarction admitted to our hospital from January 2010 to December 2013 were included in this retrospective study .Sixty cases of myocardial infarction with typical symptoms were included as the control group .Forty -six cases of myocardial infarction with atypical symptoms were included as the observed group , and these 46 patients finally were confirmed for acute myocardial infarction by invasive or non -invasive examination means .Patients of the two groups were continuously detected for changes of the concentration of hs -CRP, cTnI and CK -MB.The concentrations of hs -CRP, cTnI, CK -MB at different time points were compared between two groups .Results The concentration of CK-MB in both groups started to increase after 3~6 hours of abonormal symptoms , the peak rise at 12~24 hours, and it started to decrease after 3~5 days.The concentration of hs -CRP in both groups started to increase after 3 hours of abnormal symptoms , and remained high levels and started to decrease after 5 days.Compared to the control group , there was no significant difference about the concentrations of CK -MB, hs -CRP, cTnI between the two groups (P >0.05).Conclusion Combined detection of the concentration of CK -MB, hs-CRP, cTnI is helpful to improve the detection of acute myocardial infarction avoiding misdiagnosis , especially in the patients with atypical syndrome .%目的：探讨高敏C反应蛋白（ hs-CRP ）、肌钙蛋白Ⅰ（ cTnI ）和肌酸激酶同工酶（ CK-MB）联合检测在心肌梗死早期诊断中的应用。方法选取我院2010-01～2013-12因心肌梗死住院的患者106例，其中60例具有典型心肌梗死症状的患者设为对照组，46例不典型心肌梗死患者设为观察组，最终经过有创或者无创检查手段确诊为心肌梗死。两组患者在发病后动态监测hs-CRP、cTnI、CK-MB水平的变化。比较观察两组受试者hs-CRP、cTnI、CK-MB在不同时间点的水平，并进行统计学分析。结果观察组患者CK-MB发病后3～6 h开始升高，平均12～24 h达高峰，3～5 d左右恢复正常；hs-CRP发病后3 h开始升高，一直保持高水平，3～5 d后开始下降；cTnI发病后3～6 h开始升高，12～24 h达高峰，一直持续高水平，5 d后开始下降。与对照组比较，CK-MB、hs-CRP、cTnI开始升高的时间、达峰时间及血清水平两组之间差异无统计学意义（P＞0．05）。结论 CK-MB、hs-CRP、cTnI 联合检测有助于早期心肌梗死的诊断，尤其对于症状不明显的患者提高了诊断率、避免了漏诊和误诊。