本文選題：高敏肌鈣蛋白I　切入點：急性心肌梗死　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的探討使用高敏肌鈣蛋白I(high sensitivity cardiac troponin I,hs-cTnI)對急性心肌梗死(acute myocardial infraction,AMI)患者1小時快速分診的有效性和可行性,為hs-cTnI的臨床應(yīng)用提供理論和實踐依據(jù)。方法根據(jù)一定的入選和排除標準,選取105例急診科收治的以急性胸痛為首發(fā)癥狀的疑似AMI患者,采用循環(huán)增強熒光免疫檢測法測定入院即刻(0小時)和入院1小時患者血漿中hs-cTnI濃度。同時選取220例同期健康體檢者作為正常參考人群,測定血漿中hs-cTnI濃度,根據(jù)第99百分位數(shù)值確定hs-cTnI的cut-off值。結(jié)果hs-cTnI的cut-off值為10.67pg/m L。疑似AMI患者,入院1小時hs-cTnI濃度明顯高于正常參考人群和入院0小時(H=258.08,U=79.05、232.45,p0.01)。入院0小時hs-cTnI濃度明顯高于正常參考人群(H=258.08,U=20.06,p0.01)。最終確診為AMI的患者,入院0小時hs-cTnI濃度明顯高于其他臨床診斷者。AMI患病率隨入院0小時、1小時hs-cTnI濃度值的增大而增高。使用hs-cTnI 1小時分診方法,疑似AMI患者中,被納入排除組、入選組和觀察組的比例分別為67%、19%、14%。排除組中,AMI的靈敏度和陰性預(yù)測價值分別為90.9%、98.3%;入選組中,AMI的特異度和陽性預(yù)測值分別為91.7%、87.5%。1小時和0小時分診方法ROC曲線下面積(AUCROC)分別為0.918、0.831,前者診斷價值更高(Z=2.171,p0.05)。排除組、觀察組和入選組30天死亡率分別為0%、0%、5%;6個月死亡率分別為1.4%、6%、10%。結(jié)論疑似AMI患者,使用hs-cTnI 1小時快速分診方法,并結(jié)合心電圖等其他臨床資料,可實現(xiàn)86%的急性胸痛患者在1小時內(nèi)被安全的排除或準確的診斷。這對于縮短AMI診斷時間,降低死亡率和誤診率,減輕醫(yī)療成本和負擔具有重要的意義。
[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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R542.22

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