發(fā)布時(shí)間：2018-04-15 13:03

  本文選題：急性心肌梗死 + 心肌肌鈣蛋白T�。� 參考：《四川大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年05期

【摘要】：目的研究急性心肌梗死(AMI)患者高敏心肌肌鈣蛋白T(hs-cTnT)水平與發(fā)病時(shí)間的關(guān)系。方法以2012年1月至2013年12月因胸痛于四川大學(xué)華西醫(yī)院急診科就診的3 096例患者為研究對象,最終確診為AMI患者1 082例,男性861例,女性221例,以胸痛發(fā)生至急診就診采血為發(fā)病時(shí)間,按hs-cTnT水平變化趨勢將發(fā)病時(shí)間分為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組,分析不同發(fā)病時(shí)間段患者人數(shù)及hs-cTnT水平,計(jì)算各發(fā)病時(shí)間段患者h(yuǎn)s-cTnT水平低于傳統(tǒng)hs-cTnT閾值(14ng/L)的比例。通過研究各發(fā)病時(shí)間段胸痛患者h(yuǎn)s-cTnT水平及ROC曲線,比較新確定的cut-off值(分段閾值)與傳統(tǒng)閾值14ng/L在AMI診斷中的價(jià)值。結(jié)果 AMI發(fā)生5h內(nèi),血清hs-cTnT水平緩慢升高,5h以后升幅較大,48h左右到達(dá)峰值水平(2 000ng/L左右),48~96hhs-cTnT處于一個(gè)相對穩(wěn)定期,隨后迅速降低。1 082例AMI患者中,胸痛發(fā)生1h內(nèi)就診的患者h(yuǎn)s-cTnT水平小于14ng/L的比例為53.3%,1~2h為19.1%,2~3h為9.4%,3~4h為6.1%,4~5h為2.8%。各時(shí)間段診斷AMI的cut-off值為:胸痛時(shí)間3h,hs-cTnT cut-off值為13.5ng/L時(shí),敏感性為81.8%,特異性為80.1%;胸痛時(shí)間為3~6h,cut-off值為17.8ng/L時(shí),敏感性為94.6%,特異性為84.3%;胸痛時(shí)間6~12h,cut-off值為30.0ng/L時(shí),敏感性為95.9%,特異性為85.5%;胸痛時(shí)間≥12h,cut-off值為58ng/L時(shí),敏感性92.7%,特異性為93.3%。4條ROC曲線的曲線下面積均0.5,均有診斷價(jià)值,且以≥12h組和6~12h組診斷價(jià)值最高,3~6h組診斷價(jià)值居中,3h組診斷價(jià)值最低。6~12h組分段閾值的敏感性與傳統(tǒng)閾值相當(dāng),但特異性更高(P0.05);≥12h組的分段閾值犧牲了部分敏感性(P0.05),換取特異性的大幅提高(P0.05)。結(jié)論胸痛時(shí)間3h的hs-cTnT水平不足以診斷和排除AMI,應(yīng)至少動(dòng)態(tài)監(jiān)測5h。胸痛時(shí)間≥6h者應(yīng)使用較傳統(tǒng)閾值更高的閾值以減少誤診。
[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，

本文編號：1754228