急性心肌梗死中肌钙蛋白I和CK-MB定量检测的临床价值

急性心肌梗死(AMI)是临床常见的急性多发病.及时诊治,对挽救濒危心肌,改善愈后,降低急性期的病死率具有重要的意义.     

心肌肌钙蛋白I和肌酸激酶同工酶在诊断急性心肌梗死中的作用比较及应用

心血管疾病是发达国家的第一死因[1].急性心肌梗死（AMI）是临床上常见的危重病,其起病急骤,早期诊断对AMI患者的救治及预后都有极其重要的意义.心肌钙蛋白、心肌酶对判断心肌损伤都有一定的特异性和敏感性.     

床边快速心肌肌钙蛋白I定性检测在诊断急性心肌梗死中的应用

目的了解床边快速心肌肌钙蛋白I定性检测在诊断急性心肌梗死中的价值.方法用床边定性检测试纸条快速测定心肌肌钙蛋白I,在心肌肌钙蛋白I血浓度超过0.2 μg/L时,15分钟内在测定区内出现紫色双色带为阳性;心肌型肌酸激酶同工酶(creatine kinase-MB,CK-MB)的水平采用反应温度为37℃的酶动力学测定.结果在100例急性心肌梗死患者结果显示心肌肌钙蛋白I的敏感度高于CK-MB(P＜0.01),且阳性时间长于CK-MB(P＜0.01).结论床边快速心肌肌钙蛋白I定性检测试纸条可作为急性心肌梗死患者早期诊断及判断心肌梗死持续时间的指标.     

253例急性心肌梗死病人梗死部位分析

目的调查总结急性心肌梗死病人梗死的常见部位及其与病死率的相关性.方法回顾性分析病历,将符合诊断标准的住院病人按照不同发病部位分组,了解不同发病部位的构成比以及发病部位与病死率的关系.结果符合条件病例共253例,前壁急性心肌梗死(前壁、前间壁及广泛前壁)占总发病的58.6%,其次是急性下壁心肌梗死占29.3%,急性前壁合并下壁组心肌梗死病例病死率与其他部位梗死病死率有统计学意义(P＜0.05).结论急性心肌梗死以前壁或下壁为主,急性前壁合并下壁心肌梗死的病死率显著高于急性心肌梗死平均病死率.     

急性心肌梗死早期不同梗死面积心率变异性分析

目的分析急性心肌梗死（AMI）病人不同梗死部位、范围对心率变异性（HRV）的影响。方法选取2004年4月—2005年2月入住心内科CCU病房的发病24h内的ST段抬高型AMI病人30例。入院后动态记录心电图心肌梗死部位及范围;记录有无溶栓及溶栓药物及其他所用药物。在发病48h内（平均21.8h）及2周（14d±3d）各行动态心电图检查1次,测HRV各指标值。结果AMI病人无论极早期还是稳定期,不同梗死部位HRV各指标间均无统计学意义。AMI病人无论极早期还是稳定期梗死范围大者,HRV各指标明显减低（P〈0.05）。结论AMI病人早期梗死范围大者,HRV各指标明显减低,心功能减低,提示HRV可作为AMI病人预后预测的指标。     

血清肌钙蛋白I、肌酸激酶同工酶对急性心肌梗死诊断价值的对比研究

目的：对比研究血清肌钙蛋白I(cTnI)、肌酸激酶同工酶（CK-MB）对急心肌梗死（AMI）的诊断价值。方法：采用化学发光法定量检测17例AMI、14例不稳定性心绞痛（UA）、9例陈旧性心肌梗死（OMI）患血清中的cTnI及CK-MB。结果：17例AMI患cTnI浓度均大于1.5ng/ml，11例UA及9例OMI患cTnI浓度小于1.5ng/ml，3例UA患大于1.5mg/ml。13例AMI、5例UA和1例OMI患CK-MB浓度大于5.0ng/ml，其余患CK-MB浓度均小于5.0ng/ml。CTnI诊断AMI的敏感性为100％，特异性为86.96％，阳性预测价值为85％，阴性预测价值为100％，正确率为92.5％；CK-MB诊断AMI的敏感性为76.47％，特异性为73.91％，阳性预测价值为68.42％，阴性预测价值为80.95％，正确率为75％。结论：cTnI对急性心肌梗死的诊断价值优于CK-MB。     

血液生物学标志物预测心肌梗死面积的研究进展

急性心肌梗死（下称心梗）是一种严重威胁人类生命健康的心血管急重症,心梗后梗死面积大小与心力衰竭和心律失常等的发生有关。血液生物学标志物（尤其生物学心肌标志物）一直以来在急性心梗的诊断、危险分层、预后评估中备受关注。本文对血液生物学标志物预测心梗面积的研究进展进行综述。     

急性心肌梗死早期心电图指标与梗死面积的关系

目的 58例未接受溶栓治疗的急性心肌梗死（AMI）患，在首次就诊或入院时描记体表12导联心电图，分析其各项参数。方法 分别在入院后≥72h、7－10d、15－20d、25－30d追踪描记，用Selvester系统计算QRS积分。并对早期心电图各指标与QRS积分进行相关性分析。结果 前壁组中，ST段抬高的导联数与QRS积分之间呈显正相关（r=0.76)；而下壁组中，Ⅱ、Ⅲ、aVF导联ST段抬高的总数值与QRS积分之间有较明显的相关性（r=0.58)。结论 AMI早期心电图各指标与梗死面积之间有密切关系。AMI早期ST段抬高及异常Q波的范围和大小，可作为梗死面积的早期预测手段之一，为临床评价干预性治疗的疗效、判断预后提供1个简便方法。     

急性心肌梗死中肌钙蛋白Ⅰ和CK-MB定量检测的临床价值

急性心肌梗死（AMI）是临床常见的急性多发病。及时诊治，对挽救濒危心肌，改善愈后，降低急性期的病死率具有重要的意义。AMI的诊断主要有赖于临床胸痛症状，心电图（ECG）改变和心肌损伤标志物增高等，但临床实践表明约30％的AMI患者可以临床症状不明显；约25％的AMI患者可无明显ECG异常，因此心肌标志物在AMI诊断中起着重要作用。现对我院住院的25例AMI患者以及25例正常健康人的CK-MB和cTnI定量的检测进行回顾分析，探讨cTnI和KMB的定量检测对急性心肌梗死诊断的临床意义。     

心血管疾病中心肌肌钙蛋白I的临床应用

目的 探讨心血管疾病中心肌肌钙蛋白I(cTnI)的临床应用价值.方法 选取我院2009年3月-2011年5月收治的96例急性心肌梗死患者(AMI)作为观察组,以我院体检的80例健康体检者作为对照组.对照组体检时空腹抽取静脉血;AMI组于发病后4 h取血,以后每4 h取血1次,24 h后每天取血1次,直至7 d.采用自动化学发光分析仪检测心肌肌钙蛋白I(cTnI)、肌红蛋白(Myo)以及肌酸激酶同工酶(CK-MB)三项指标,比较这3项指标对AMI诊断的敏感性和特异性.结果 AMI组的cTnI、Myo以及CK-MB水平明显高于对照组(P<0.05),cTnI、Myo、CK-MB对AMI的敏感性分别为98.7%、90.0%、80.0%;特异性分别为96.9%、85.4%、94.8%.结论 急性AMI患者的cTnI、MB、CK-MB的值均明显升高,3项指标对AMI均有较高的灵敏度和特异性,其中以cTnI最佳.     

血清TpP、hs-CRP、CKMB、cTnI在急性心肌梗死中的诊断意义

目的探讨血栓前体蛋白(TpP)、高敏C反应蛋白(hs-CRP)、肌酸激酶同工酶(CKMB)及心肌肌钙蛋白I(cTnI)联合检测在急性心肌梗死(AMI)中的诊断价值。方法 测定26例急性心肌梗死患者胸痛发作6小时内及24小时TpP、hs-CRP、CKMB及cTnI。结果AMI胸痛发作6小时内TpP的敏感性最高,发病6小时后hs-CRP、CKMB及cTnI显著升高,cTnI阳性持续时间长,而hs-CRP在AMI时可出现明显升高。结论TpP对于AMI具有早期诊断价值,cTnI与hs-CRP、CKMB一起相互补充,具有重要的临床诊断及判断预后的意义。     

Circulating miR-130 is a potential bio signature for early prognosis of acute myocardial infarction

BackgroundAs distinctive leading reasons of death globally, acute myocardial infarction (AMI). Accounts for major death ratio, caused by coronary artery disease (CAD). Its diagnosis relies on the presenting clinical symptoms, electrocardiograms (ECGs), and levels of circulating biomarkers. Recent studies have implicated microRNAs (miRNAs) in the pathogenesis of many diseases, including AMI. The present study inquire into feature value of miR-130 in AMI patients.Methodslevels of expression of miR-130 in patient plasma, considered through simultaneous quantitative polymerase chain reaction (qRT-PCR). The method used for determining Plasma cardiac troponin I (cTnI) & creatine kinase-MB(CK-MB) degree set on by enzyme-linked immunosorbent assay (ELISA). The diagnostic value of miR-130 was measured using a receiver operating characteristic (ROC) curve.ResultsPlasma miR-130, cTnI, and CK-MB levels exist remarkably inflated in the AMI classification in comparison with control category (P<0.05). MiR-130 expression peaked 6 hours after disease onset, earlier than cTnI and CK-MB. The level of expression of miR-130 6 hours after disease onset was positively correlated with cTnI and CK-MB levels 12 hours after onset. The optimal cut-off point for miR-130 in peripheral blood, sensitivity, and specificity were 1.58 ng/mL, 82.5% and 77.5%, respectively. The area under curve (AUC) was 0.922.ConclusionsThese results indicate that circulating miR-130 holds great promise as an effective biomarker for diagnosing AMI earlier.     

Comparison between Contrast‐Enhanced Magnetic Resonance Imaging and Selvester QRS Scoring System in Estimating Changes in Infarct Size between the Acute and Chronic Phases of Myocardial Infarction

Background: The Selvester QRS score was developed as a method to estimate infarct size (IS) using the ECG and has been validated during the prereperfusion era. Few comparisons exist with contrast‐enhanced magnetic resonance imaging (ceMRI) in reperfused patients. This study evaluates the ability of the Selvester QRS score to estimate serial changes in IS during the acute and chronic phases of the infarct evolution in patients who have received reperfusion therapy. Methods: Thirteen patients with acute myocardial infarction underwent serial ceMRI studies in the acute (<1 week) and chronic phase (>2 months) after their initial myocardial infarction. QRS scoring was performed on the corresponding ECGs. The correlation between ceMRI measurement and QRS score estimation of IS was determined at both time points and for the difference between the two phases. Results: The mean IS was 20.1 ± 11.0% of total left ventricular mass (% LV) in the acute phase and 13.3 ± 6.4% LV in the chronic phase ceMRI. The mean IS estimated by Selvester QRS score in the acute and chronic phases were 18.7 ± 8.2% and 16.4 ± 8.5% LV, respectively. A modest correlation was found for the acute (r = 0.57) and chronic phase IS (r = 0.54). However, there was no correlation for the difference in IS between the acute and chronic phases. Conclusions: In this pilot study, the Selvester QRS score correlates modestly to IS by ceMRI during both the acute and chronic phases of the infarction process. The serial changes over time in the Selvester QRS score and IS by ceMRI show no correlation.     

3种心肌标志物在急性心肌梗死早期诊断中的价值

目的探讨肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)3种心肌标志物检测对急性心肌梗死(AMI)早期诊断的价值。方法用胶体金免疫层析法测定120例心肌梗死患者的3种血清心肌标志物的浓度,比较其对AMI诊断的性能价值。结果 120例心肌梗死患者在胸痛发作6h内检测cTnT、CK-MB和MYO的敏感率分别是81.4%、60.5%和97.7%,以MYO浓度升高最快,出现最早;发病6h～24h内检测cTnT、CK-MB和MYO的敏感率分别是99.0%、79.4%和79.0%,以cTnT浓度最稳定;在发病8h内检测cTnT、CK-MB和MYO的敏感性分别为91.0%、70.0%和99.0%,特异性分别为100%、91.0%和79.0%;漏诊率分别是9.0%、30.0%和1.0%;误诊率分别是0、9.0%和21.0%。结论 cTnT在AMI早期诊断中具有较高的敏感性、特异性和准确性,是早期诊断AMI的"金指标",MYO可作为AMI的过筛,三者结合可提高早期AMI的诊断率,并有助于病情的分析。     

急性心肌梗死患者合并左心衰与肌钙蛋白Ⅰ、肌红蛋白浓度的关系

目的探讨肌钙蛋白I(cTnI)、肌红蛋白(Mb)浓度与急性心肌梗死(AMI)合并左心衰的关系。为左心衰患者的临床诊断提供依据。方法AMI无合并心力衰竭组171例,于胸痛发作后3h抽静脉血3mL送检。AMI合并左心衰组127例,于胸痛发作后3h表现为有左心衰症状时抽静脉血3mL。采用全自动微粒子化学发光分析仪定量检测cTnI、Mb。结果AMI无合并心衰组cTnI的浓度为(16.71±14.19)μg/L,Mb的浓度为(522.22±392.22)μg/L。AMI患者cTnI于胸痛3h后随时间增加而逐步增高,有左心衰症状时cTnI的浓度为(29.08±21.97)μg/L,Mb的浓度为(1010.96±935.98)μg/L,两组比较有统计学意义(P<0.05)。结论AMI患者cTnI浓度与心肌梗死部位及面积大少有关,cTnI浓度的测定对AMI合并左心衰的诊治有较大意义。     

Presentations of Acute Myocardial Infarction in Men and Women

OBJECTIVE: To assess the influence of gender on the likelihood of acute myocardial infarction (AMI) among emergency department (ED) patients with symptoms suggestive of acute cardiac ischemia, and to determine whether any specific presenting signs or symptoms are associated more strongly with AMI in women than in men. DESIGN: Analysis of cohort data from a prospective clinical trial. SETTING: Emergency departments of 10 hospitals of varying sizes and types in the United States. PATIENTS: Patients 30 years of age or older (n = 10,525) who presented to the ED with chest pain or other symptoms suggestive of acute cardiac ischemia. MEASUREMENTS AND MAIN RESULTS: The prevalence of AMI was determined for men and women, and a multivariable logistic regression model predicting AMI was developed to adjust for patients' demographic and clinical characteristics. AMI was almost twice as common in men as in women (10% vs 6%). Controlling for demographics, presenting signs and symptoms, electrocardiogram features, and hospital, male gender was a significant predictor of AMI (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.4, 2.0). The gender effect was eliminated, however, among patients with ST-segment elevations on electrocardiogram (OR 1.1; 95% CI 0.7, 1.7) and among patients with signs of congestive heart failure (CHF) (OR 1.1; 95% CI 0.8, 1.5). Signs of CHF were associated with AMI among women (OR 1.9; 95% CI 1.4, 2.6) but not men (OR 1.0; 95% CI 0.8, 1.3). Among patients who presented to EDs with chest pain or other symptoms suggestive of acute cardiac ischemia, AMI was more likely in men than in women. Among women with ST-segment elevation or signs of CHF, however, AMI likelihood was similar to that in men with these characteristics.     

Consistency analysis of high-sensitivity cardiac troponin I in peripheral blood and venous blood by quantum dot immunofluorescence assay and clinical application in acute myocardial infarction

BackgroundTroponin is an important marker for the diagnosis of acute myocardial infarction (AMI). The detection of troponin in peripheral blood is simpler and more convenient than that in venous blood, which has attracted more and more clinical attention. The purpose of this study is to establish a novel method for the rapid detection of high-sensitivity troponin I (hs-cTnI) in peripheral blood by quantum dot fluorescence immunoassay and evaluated the clinical accuracy of the method.MethodsA total of 90 patients with chest pain admitted to Wuxi Second People’s Hospital of Nanjing Medical University had peripheral blood and venous blood samples collected for detection of hs-cTnI by rapid quantum dot fluorescence immunoassay. The differences between the two methods were evaluated, as well as the analytical performance and clinical diagnostic efficacy of hs-cTnI detection by quantum dot fluorescence immunoassay. The final diagnosis was determined by two independent cardiologists.ResultsThis study verified the precision, linear range and sensitivity of the novel detection method. There was good correlation between the results of hs-cTnI quantum dot fluorescence immunoassay for peripheral blood and the results for venous blood (regression equation Y=1.026x+0.521, R²=0.9337); 94.4% (85/90) of the data were within the conformance limit. In addition, in the analysis of 52 patients with confirmed AMI, the clinical specificity of the quantum dot fluorescence immunoassay in peripheral blood was the same as that in venous blood samples (89.5%:89.5%). Finally, the area under the receiver operating characteristic (ROC) curve of the peripheral blood quantum dot fluorescence immunoassay was 0.9352, the 95% confidence interval (CI) was 0.8829 to 0.9876, the cut-off value was 1.598, and the sensitivity was 82.69%, which was not significantly different from the venous blood method (P value =0.089).ConclusionsRapid detection of hs-cTnI by quantum dot fluorescence immunoassay in peripheral blood is feasible. It has a high correlation and consistency with the venous blood method, as well as a high clinical diagnostic value for AMI and is more convenient and easier to detect.     

益气宁心汤联合重组人脑利钠肽治疗急性心肌梗死伴心力衰竭的临床研究

目的观察益气宁心汤联合重组人脑利钠肽(rhBNP)治疗急性心肌梗死(AMI)伴心力衰竭(HF)的临床疗效。方法选取大连市第二人民医院2019年3月—2021年2月收治的AMI伴HF病人113例为研究对象,通过抽签法随机分为联合组(57例)和对照组(56例),两组病人均给予常规药物治疗,在此基础上,对照组给予rhBNP治疗,联合组在对照组基础上加用益气宁心汤治疗,比较两组临床疗效、心功能[左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)及舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度(E/A)比值]、血管内皮功能[一氧化氮(NO)、血管内皮素-1(ET-1)、超敏C反应蛋白(hs-CRP)和血栓素B₂(TXB₂)]及血清肌酸激酶同工酶(CK-MB)、脂联素(APN)和肌钙蛋白I(cTnI)水平。结果治疗后,联合组总有效率为96.49%,明显高于对照组的83.93%(P<0.05)。治疗后,两组LVEF、E/A比值、NO、APN水平均较治疗前明显升高(P<0.05),LVEDV、LVESV、ET...     

血清ApoB/ApoA1、CK-MB、cTnI水平与冠心病患者冠状动脉狭窄程度的关系

目的探讨血清载脂蛋白B(ApoB)/血清载脂蛋白A1(ApoA1)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平与冠心病(CHD)患者冠状动脉狭窄程度的关系。方法选择120例冠心病患者作为CHD组,另选择40例同期健康体检者作为正常组,比较正常组和CHD组ApoB/ApoA1、CK-MB及cTnⅠ水平差异。此外,按照Gensini评分将CHD组患者分为轻、中、重度狭窄组三组,分别为25例、52例、43例,比较不同狭窄程度CHD患者ApoB/ApoA1、CK-MB及cTnⅠ水平差异。并采用Spearman法分析ApoB/ApoA1、CK-MB及cTnⅠ水平与冠状动脉狭窄程度的相关性。结果 CHD组ApoB/ApoA1、CK-MB、cTnI水平较正常组明显升高(P0.05)。中度狭窄组ApoB/ApoA1、CK-MB、cTnⅠ水平较轻度狭窄组明显升高(P0.05),且重度狭窄组较轻、中度狭窄组明显升高(P0.05)。冠心病患者ApoB/ApoA1、CK-MB及cTnI水平与冠状动脉狭窄程度均呈正相关(r分别为0.694、0.920、0.930,P0.05)。结论冠心病患者血清ApoB/ApoA1、CK-MB及cTnⅠ水平与冠状动脉狭窄程度呈正相关。     

血清CRP、IL-6水平与急性脑梗死相关关系的研究

目的探讨CRP和IL-6与急性脑梗死不同临床类型的关系及其在急性脑梗死发生发展中的意义。方法 62例脑梗死患者分为进展型卒中32例,完全型卒中30例。正常对照组30例。入院24h内检测血清CRP与IL- 6。结果进展型卒中与完全型卒中患者血清CRP、IL-6水平均高于对照组,进展型卒中患者CRP、IL-6水平亦均高于完全型卒中患者,差异有非常显著性意义(P<0．01)。结论炎症反应与免疫反应可能参与了急性脑梗死的发生发展。而CRP、IL-6水平在不同临床类型脑梗死升高程度不同,可能与动脉粥样硬化斑块的稳定性有关。