cTnI快速定量检测在诊断非ST段抬高型急性心肌梗死中的应用

目的:探讨肌钙蛋白I(cTnI)快速定量检测在诊断非ST段抬高型急性心肌梗死(NSTEMI)中的优越性,进一步推广在基层医院临床中的应用.方法:选取住院怀疑为NSTEMI的85例患者作为对象,抽取入院即刻、24h血清,同步检测cTnI、肌酸激酶同工酶(CK-MB),结合临床、心电图对NSTEMI作出诊断,对两种方法的差异进行统计学分析.结果:NSTEMI患者早期cTnI的阳性率明显高于CK-MB,cTnI在诊断NSTEMI上具有简便快速,出现时间早,诊断窗口时间长等优点,可有效防止漏诊.结论:cTnI快速定量检测方法简便,敏感性高、特异性强,在诊断NSTEMI中具有重要意义,可在基层医院中推广应用.     

NSTEMI患者血清hs-CRP、 cTnI和D-D检测的临床评价

目的:探讨非ST抬高型急性心肌梗死(NSTEMI)患者血清hs-CRP、cTnI和D-D水平变化的临床意义.方法:应用免疫比浊法、生化法和酶联法对66例疑NSTEMI患者进行了血清hs-CRP、cTnI和D-D检测,并根据临床诊断分成观察组和对照组,进行统计学分析.结果:NSTEMI患者血清hs-CRP、cTnI和D-...     

NSTEMI患者血清IL-6、cTnI和TNF-α检测的临床评价

目的:探讨非ST抬高型急性心肌梗死(NSTEMI)患者血清IL-6、cTnI和TNF-α水平的变化的临床意义。方法:应用放射免疫分析和生化法对62例怀疑NSTEMI患者进行了血清IL-6、cTnI和TNF-α检测,并根据临床诊断分成观察组和对照组,进行统计学分析。结果:NSTEMI患者血清IL-6、cTnI和TNF-α水平均非常显著地高于对照组。且血清IL-6水平与cTnI和TNF-α水平呈显著正相关(r=0.5782、0.6024,P<0.01)。结论:血清IL-6、cTnI和TNF-α水平升高与NSTEMI的预测、诊断和预后均有一定的临床价值。     

肌钙蛋白I与磷酸肌酸同功酶在病毒性心肌炎检测中的临床诊断价值探讨

目的了解肌钙蛋白I(cTnI)和磷酸肌酸同功酶(CK-MB)检测在病毒性心肌炎中的临床应用价值.方法对临床确诊为柯萨奇B组病毒感染的48例病毒性心肌炎患者检测cTnI和CK-MB.结果 cTnI阳性37例(77.08%),而CK-MB阳性13例(27.08%)(p＜0.001).结论 cTnI是心肌细胞受到病毒性损伤的可靠的特异性诊断指标.     

外周血 cTnI 联合心肌酶谱检测在老年急性心肌梗死诊断中的应用研究

目的:分析外周血cTnI联合心肌酶谱检测在老年急性心肌梗死诊断中的应用价值.方法:回顾性分析我院2019年4月至2020年8月收治的62例老年急性心肌梗死(研究组)患者临床资料;另选取同期于本院进行健康体检者62例(对照组).比较两组肌钙蛋白I(Cardiac troponin I,cTnI),心肌酶四项[包括乳酸脱氢酶(Lactate dehydrogenase,LDH)、谷草转氨酶(Aspartate transaminase,AST)、肌酸激酶(Creatine Kinase,CK)以及肌酸激酶同工酶(creatine kinase-MB,CK-MB)]的水平,并分析cTnI、心肌酶谱四项检测及两者联合检测诊断急性心肌梗死的敏感性与特异性.结果:研究组血清cTnI、LDH、AST、CK、CK-MB水平均高于对照组(P<0.05).cTnI联合心肌酶谱四项检测敏感性及特异性均高于单一cTnI、心肌酶谱检测(P<0.05).结论:心肌酶谱与cTnI联合诊断急性心肌梗死敏感性、特异性更高,可有效降低漏诊和误诊的风险.     

肌钙蛋白I与磷酸肌酸同功酶在病毒性心肌炎检测中的临床诊断价值探讨

目的了解肌钙蛋白I(cTnI)和磷酸肌酸同功酶(CK-MB)检测在病毒性心肌炎中的临床应用价值.方法对临床确诊为柯萨奇B组病毒感染的48例病毒性心肌炎患者检测cTnI和CK-MB.结果cTnI阳性37例(77.08%),而CK-MB阳性13例(27.08%)(p<0.001).结论cTnI是心肌细胞受到病毒性损伤的可靠的特异性诊断指标.     

高敏心肌肌钙蛋白T检测在急性心肌梗死诊断中临床应用

目的 探讨高敏肌钙蛋白T(hs-cTnT)在急性心肌梗死(AMI)诊断中的临床应用价值.方法 采用电化学发光免疫法对240例AMI患者血清hs-cTnT及常规cTnI水平进行检测,同时绘制受试者工作特征曲线(ROC),根据曲线建立临床适用的hs-cTnT诊断界值,并比较hs-cTnT及常规cTnI对AMI诊断的准确性.结果 AMI组患者血清hs-cTnT水平均高于0.014ng/mL(健康人群99百分位值),其中ST抬高型心肌梗死(STEMI)患者组水平高于非ST抬高型心肌梗死(NSTEMI)患者组(x2=68.573,P＜0.05);hs-cTnT的ROC曲线下面积(AUC)为0.905,显著高于传统cTnI的0.793(Z=2.896,P＜0.05),hs-cTnT联合CK-MB可使AUC从0.905增加至0.954(Z =2.098,P＜0.05),以0.014ng/mL作为cut-off值时,其对AMI诊断敏感度可达100％,但特异度仅为45.5％,以Youden指数最高(0.654)对应的0.035ng/mL作为cut-off值时,对AMI的诊断综合能力最强,敏感度为91.8％,特异度为74.9％.结论 hs-cTnT对AMI的诊断价值要优于传统cTnI检测,但其在提高诊断灵敏度的同时,也会使很多非AMI疾病患者hs-cTnT水平超过诊断界值,应注意鉴别诊断;以ROC曲线Youden指数最高对应的hs-cTnT数值作为AMI的诊断界值,在临床实践中更为适用.hs-cTnT检测与临床应用方面仍有许多问题有待解决,还需要进一步临床研究证实.     

新一代肌钙蛋白Ⅰ和T对急性心肌梗死诊断的比较研究

为比较新一代肌钙蛋白I(cTnI)和T(cTnT)水平在急性心肌梗死(AMI)早期的诊断价值, 用Access化学发光仪和Elecsys电化学发光仪, 分别检测126例疑为急性冠状动脉综合征患者入院不同时间血清cTnI和cTnT水平,通过ROC曲线分析比较两者在AMI早期的诊断价值, 并同时检测肌酸激酶同工酶质量.结果显示: 入院即刻、入院后4h和8h, AMI组血清cTnI和cTnT水平显著高于不稳定型心绞痛组和其他疾病组(P＜0.01).cTnI和cTnT对AMI的诊断价值基本相同, 但在入院即刻, 以cutoff值为判定值时, cTnI比cTnT有更高的灵敏度(P＜0.05),表明cTnI和cTnT是诊断AMI高灵敏度和高特异性的血清标志物, cTnI在AMI初期灵敏度更高, 动态观察血清cTnI和cTnT浓度变化对AMI的诊疗具有重要的临床价值.     

急性冠脉综合征患者血清中缺血修饰白蛋白检测的研究

目的 探讨缺血修饰白蛋白(IMA)在急性冠脉综合征(ACS)早期诊断中的临床应用价值;评价缺血修饰白蛋白与其他心脏标志物在急性冠脉综合征中联合检测的诊断效能.方法 采集6小时内持续急性胸痛的患者血清标本163例,采用白蛋白-钴结合试验法(ACB法)检测其缺血修饰白蛋白水平,同时采用化学发光免疫法检测其血清肌钙蛋白Ⅰ(cTnI)、肌红蛋白(MYO)水平,采用酶速率法检测肌酸激酶同工酶MB(CK-MB)水平.结果 急性冠脉综合征组血清IMA、cTnI、MYO和CK-MB中位数水平均高于非缺血性胸痛(NICP)对照组(P＜0.05).以血清IMA水平85U/mL、cTnI水平0.1 g/mL、MYO水平65.8ng/mL和CK-MB水平24U/L作为诊断ACS患者和NICP对照者的临界值,ROC曲线下面积分别为0.89、0.83、0.72和0.76.对比IMA、cTnI、MYO与CK-MB四项指标单独检测,四者联合检测提高了ACS患者的诊断效率.结论 IMA是一种有用的、敏感的早期诊断冠状动脉综合征的心脏生物学标志物.IMA、cTnI、MYO和CK-MB联合检测能够提高急性冠脉综合征的诊断效率.     

非心肌损伤患者心肌标志物水平升高情况分析

目的 结合临床诊断情况分析非心肌疾病患者肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和肌钙蛋白I(cTnI)检测结果升高原因,以便更好指导临床患者的诊治,避免误诊.方法 选取2020年1月至2021年1月本院门诊及住院检测过CK、CKMB、cTnI患者的血清样本,结合临床诊断分析各指标升高的可能原因.结果 38例cT...     

CHD患者治疗前后血清cTnI、NPY和PGMP检测的临床意义

目的：探讨冠心病（CHD）患者治疗前后血清肌钙蛋白I（cTnI）、神经肽Y（NPY）和血小板α-颗粒膜蛋白（PGMP）水平的变化及临床意义。方法：应用放射免疫分析和生化法测定了41例CHD患者血清cTnI、NPY和PGMP含量,并与35名正常健康人作比较。结果：CHD患者在治疗前血清cTnI、NPY和PGMP含量均非常显著地高于正常人组（P〈0.01）,经治疗6个月后cTnI、NPY水平与正常人组比较无显著性差异（P〉0.05）,而PGMP水平与正常人组比较仍有显著性差异（P〈0.05）。结论：CHD的发生、发展与血清cTnI、NPY和PGMP水平密切相关。     

体外循环手术围手术期检测血清肌钙蛋白I和超敏C反应蛋白的临床意义

探讨在体外循环手术围手术期检测血清肌钙蛋白I(cTnI)和超敏C反应蛋白(hs-CRP)的临床意义。选择46例进行体外循环手术的先天性心脏病的患者围手术期中几个时期的血液(包括术前、术后即刻、术后24h、3d、7d、15d),测定cTnI和hs—CRP的浓度,同时记录心电图(ECG)、血流动力学指标及不良事件发生情况。结果表明术前cTnI和hs—CRP的测定结果均在正常范围内,术后即刻、24h、3dcTnI均显著性增高,以24h增高最为显著,术后7d以后趋于正常;hs—CRP于术后24h开始显著性增高,至7d后逐渐降低。合并术后感染的患者术后3d-7dhs—CRP与术后无合并感染患者相比明显增高,经抗炎治疗术后15d趋于正常。cTnI和hs-CRP可以作为体外循环手术预后状况判定的诊断指标,并且通过观察围手术期hs—CRP的浓度变化可以对术后感染进行预防。     

快速固相免疫层析法测定心肌肌钙蛋白I及在AMI诊断中的应用

为探讨采用快速固相免疫层析法测定心肌肌钙蛋白Ⅰ(cTnI) 和选择性免疫抑制紫外法测定肌酸激酶同工酶(CK-MB)及在急性心肌梗死(AMI) 诊断中的价值,本文分别对52例AMI患者于胸痛发生后4、8、12、24、48h及第5、7d和26名正常对照者的血清进行了cTnI及CK-MB 的测定.结果表明,AMI组血清cTnI、CK-MB 的测定值均明显高于正常对照组,具有显著性差异(P<0.01 );AMI患者cTnI在4h及第5、7d时的阳性率均明显高于CK-MB,具有显著性差异(P<0.01 ).以上数据表明,cTnI在诊断急性心梗中具有较高的灵敏度及高度特异性,尤其是采用快速固相免疫层析法检测cTnI,可为快速诊断AMI提供依据,具有临床应用价值.     

Troponine Ic et CK-MB après pontage coronarien avec ou sans CEC

The aim of this work was to investigate the release profile of cardiac troponin I and CK-MB after coronary artery bypass grafting with and without cardiopulmonary bypass. In patients without postoperative cardiac complications, cTnI peak was observed 24 h after coronary artery bypass grafting both with and without cardiopulmonary bypass. The CK-MB peak was observed 24 h after surgery without cardiopulmonary bypass but as soon as 3 h after surgery with cardiopulmonary bypass. Moreover, cTnI and CK-MB concentrations were 2–3-fold higher with cardiopulmonary bypass than without. In patients with postoperative myocardial infarction, the cTnI and CK-MB peaks were observed 24 h after coronary artery bypass grafting both with and without cardiopulmonary bypass. Diagnosis of preoperative myocardial infarction can be suggested at 24 h with cTnI cut-off values seven or three fold higher than the cut-off value in medical cardiology (ROC curve) with or without cardiopulmonary bypass, respectively.     

Cardiac troponin I and CK-MB mass after cardiac surgery with cardiopulmonary bypass

Cardiac troponin I (cTnI) assay is used in the diagnosis of myocardial infarction after cardiac surgery. Variations in the cut-off value have been reported even with the same assay method. The aim of this work is to investigate the release profile of cTnI and CK-MB mass after cardiac surgery and to determine the cut-off value of cTnI and CK-MB mass allowing the diagnosis of perioperative myocardial infarction. In patients without postoperative cardiac complication, the cTnI peak was observed 24 hours after surgery both in coronary artery bypass grafting and in valve replacement. Moreover, the amount of cTnI released within the three hours after surgery is 2.5 fold higher in valve replacement than in coronary artery bypass grafting. The CK-MB peak was observed 3 hours after surgery in the two surgical procedures. In these patients, cTnI and CK-MB concentrations increased with the cross clamp time duration. In patients with postoperative myocardial infarction, the cTnI and CK-MB peaks were observed 24 hours after surgery. Diagnosis of perioperative myocardial infarction can be performed with a sensitivity of 100% at 24 hours with cut-off values of 32 and 7 microg/L for CK-MB and cTnI, respectively, both with Stratus (Dade Behring) and Immulite (DPC) analysers.     

Discordant results of CK-MB and troponin I measurements: a review of 14 cases

In the course of a clinical comparison involving 204 parallel total creatine kinase (CK), creatine kinase-MB isoenzyme (CK-MB), and cardiac troponin I (cTnI) measurements, 12 patients were identified in whom cTnI was elevated while total CK was normal, as well as 2 patients in whom CK-MB was elevated while cTnI was normal. CK-MB relative index was elevated in 6 of the twelve cTnI-positive patients with normal total CK; only 2 of these patients had a discharge diagnosis of acute myocardial infarction (AMI). All of the 12 patients in this group had medical conditions that are associated with greater risk for acute cardiac events. Both patients with normal cTnI but elevated total CK and CK-MB index had chronic renal insufficiency; one of these patients had a positive stress test and a diagnosis of AMI. The other cTnI-negative patient died 2 days after admission, and autopsy revealed evidence of ischemic changes, but not acute infarction. Significant differences were apparent between traditional CK-MB results and cTnI measurements. Using total CK elevation as a prerequisite for subsequent CK-MB measurement may limit the clinical sensitivity of this enzyme marker for detecting subacute ischemic damage to the myocardium. Elevated total CK and CK-MB isoenzyme without corresponding elevations in cTnI, on the other hand, may reflect changes in enzyme elimination kinetics due to renal failure, or cross-reactivity of the cTnI assay with non-cardiac antigens.     

Troponin I, laboratory issues, and clinical outcomes in a district general hospital: crossover study with "traditional" markers of myocardial infarction in a total of 1990 patients

AIMS: Review of the clinical outcomes and practical issues of replacing traditional cardiac enzymes with troponin I (cTnI) in a district general hospital. METHODS: Crossover study of three sequential three month stages during which serial cardiac enzymes were replaced with a single cTnI measurement available at three set times within 24 hours for the duration of the second three month stage. The study was carried out in a 630 bed district general hospital with 1990 admissions of suspected cardiac ischaemia over the study period as a whole. Account was taken of seasonal factors. RESULTS: The introduction of troponin was associated with 8.5% more patients with non-ischaemic heart disease (IHD) being discharged on the day after admission, saving approximately 107 bed days each year. Approximately 50% more patients were diagnosed with myocardial infarction during the cTnI stage. There was no increase in readmission within one month or early death with cTnI. Approximately 3% false positive and 1.5% false negative cTnI results were recorded. All false positive cTnI results were coding errors or attributable to known assay interference effects. All false negatives were potentially explained by sample timing factors. The lack of standardisation in troponin assay services impacts clinically. CONCLUSION: Younger patients without IHD were discharged earlier during the cTnI stage in apparent safety. Blood sample timing needs to be verified when cTnI is used as an adjunct to early discharge. There were no unexplained false positives or negatives. Standardisation related issues arose.     

血浆cTnI水平对化疗药心肌毒性的诊断意义

目的:评价血浆肌钙蛋白Ⅰ(cTnI)在化疗药心肌毒性的早期诊断价值.方法:89例肿瘤病人,化疗前及化疗各周期分别检测血浆cTnI,肌酸磷酸激酶(CK-Mb),超声心动图(UCG)及心电图(ECG).对比化疗前、化疗各周期各指标的变化.结果:化疗各周期与化疗前对比,患者UCG、ECG、临床症状无明显变化;化疗前、化疗各周期,cTnI均值及阳性率水平变化差异显著;CK-Mb均值差异显著,而阳性率变化差异显著.结论:cTnI可做为肿瘤化疗药心肌毒性的早期敏感特异性指标.     

cTnI水平与非心源性危重症患者预后的相关性

目的：探讨血清cTnI与非心源性危重症患者病情严重程度和预后的相关性。方法：将66例非心源性危重症患者根据入院后96h内cTnI是否有异常升高,分为高危组和低危组,分析两组患者急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）分值、ICU住院时间、ICU住院费用、机械通气情况、30d病死情况的差异。结果：高危组的APACHEⅡ评分、ICU住院时间、ICU住院费用、机械通气人次、30d内病死人数均高于（多于）低危组（P〈0.05或P〈0.01）。结论：非心源性危重症患者血清cTnI的含量可在相当程度上反映患者病情的严重程度,并对患者的短期病死率预估有一定的帮助;因此cTnI可作为APACHEⅡ评分系统之外评价危重症患者病情与预后的重要指标。