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中华临床实验室管理电子杂志

中华临床实验室管理电子杂志 ›› 2021, Vol. 09 ›› Issue (03) : 160 -163. doi: 10.3877/cma.j.issn.2095-5820.2021.03.007

实验研究

急性心肌梗死患者心肌损伤指标和炎性指标的临床意义
符符1,†(), 董航2, 宋琛3   
  1. 1. 464400　河南淮滨，淮滨县第二人民医院心血管内科
    2. 453003　河南新乡，新乡医学院医学检验学院
    3. 453100　河南卫辉，新乡医学院第一附属医院血液科
  • 收稿日期:2020-11-06 出版日期:2021-08-26
  • 通信作者: 符符

Clinical significance of myocardial injury index and inflammatory index in patients with acute myocardial infarction

Fu Fu1,†(), Hang Dong2, Chen Song3   

  1. 1. Department of Cardiovascular Medicine, Second People's Hospital of Huaibin County, Huaibin Henan 464400, China
    2. School of Medical Laboratory Science Xinxiang Medical Universi, Xinxiang Henan 453003, China
    3. Department of Hematology, First Affiliated Hospital of Xinxiang Medical College, Weihui Henan 453100, China
  • Received:2020-11-06 Published:2021-08-26
  • Corresponding author: Fu Fu
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符符, 董航, 宋琛. 急性心肌梗死患者心肌损伤指标和炎性指标的临床意义[J]. 中华临床实验室管理电子杂志, 2021, 09(03): 160-163.

Fu Fu, Hang Dong, Chen Song. Clinical significance of myocardial injury index and inflammatory index in patients with acute myocardial infarction[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2021, 09(03): 160-163.

目的

观察急性心肌梗死(AMI)患者血液心肌损伤标志物、炎症因子的表达水平，并探讨其临床意义。

方法

选择河南省淮滨县第二人民医院收治的首发AMI患者112例为试验组，选择同期健康体检者120例作为对照组。采用速率法检测肌酸激酶同工酶(CK-MB)、化学发光法检测B型利钠肽(BNP)、荧光免疫法检测N端脑钠肽前体(NT-proBNP)、胶乳增强免疫比浊法检测肌红蛋白(MYO)和心肌肌钙蛋白I(cTnI)、散射比浊法检测超敏C-反应蛋白(hs-CRP)、循环酶法检测同型半胱氨酸(HCY)、ELISA检测IL-6和IL-8，比较两组间检测指标的差异。通过制作受试者工作特征曲线(ROC)，评价各检测指标的特异性和敏感性。

结果

AMI患者血液CK-MB、MYO、cTnI、BNP、NT-proBNP、IL-6、IL-8、hs-cRP、HCY水平均显著高于对照组。ROC曲线显示，MYO、BNP、NT-proBNP、IL-6、IL-8、HCY具有较好的辅助诊断AMI效能(AUC＞0.9)，cTnI、MYO、BNP、NT-proBNP、IL-6、IL-8、HCY具有较好的特异性(＞94%)，CK-MB、NT-proBNP、HCY(＞94%)具有较好的敏感性。

结论

检测血液HCY、NT-proBNP水平对辅助诊断AMI具有较好的临床应用价值。

关键词: 心肌梗死, 肌红蛋白, 肌钙蛋白Ⅰ, C反应蛋白质, 白介素, 利钠肽
Objective

To observe the expression levels of myocardial injury markers and inflammatory factors in patients with acute myocardial infarction (AMI), and to explore their clinical significance.

Methods

112 patients with first-episode AMI admitted to our hospital were selected as the experimental group and 120 healthy subjects in the same period as the control group. Serum CK-MB, BNP, NT-proBNP were detected by rate method, chemiluminescence method, fluorescence immunoassay, respectively. Latex enhanced immunoturbidimetry was used to detect serum MYO and cTnI, scattering turbidimetry for hs-CRP, and circulating enzyme method for IL-6 and IL-8. The differences of indexes between the two groups were compared. The specificity and sensitivity of each index were evaluated by making the working characteristic curve of the subjects (ROC).

Results

The levels of serum CK-MB, MYO, cTnI, BNP, NT-proBNP, IL-6, IL-8, hs-CRP and HCY in patients with AMI were significantly higher than those in the control group. ROC curve showed that there was of good efficacy in MYO, BNP, NT-proBNP, IL-6, IL-8 and HCY in assistant diagnosis of AMI (AUC＞0.9), good specificity in cTnI, MYO, BNP, NT-proBNP, IL-6, IL-8 and HCY(＞94%), and good sensitivity in CK-MB, NT-proBNPand HCY (＞94%).

Conclusions

The detection of blood HCY and NT-proBNP levels has a good clinical value for the auxiliary diagnosis of AMI.

Key words: Myocardial infarction, Myoglobin, Troponin Ⅰ, C-reactive protein, Interleukin, Natriuretic peptide
表1 两组人员的一般资料比较
组别 n(例) 年龄(岁) 性别(男/女) BMI(kg/cm2) 吸烟(%) 高血压(%) LVEF(%)
对照组 120 63. 2±5.4 68/52 19.81±1.92 23.3(28/120) 56.7(68/120) 53.28±6.82
病例组 112 57.6±7.2 67/45 22.57±2.10 29.5(33/112) 67.9(76/112) 44.02±5.33a
表2 AMI患者心肌损伤指标的变化
组别 n(例) CK-MB(μg/L) BNP(ng/L) NT-proBNP(ng/L) MYO(μg/L) cTnI(μg/L)
对照组 120 1.21±0.69 52.71±5.29 387.52±41.09 18.74±5.20 1.82±0.29
病例组 112 3.75±1.03a 81.25±7.66b 987.64±86.24b 84.21±12.49b 12.37±5.05b
F值 3.82 6.94 7.49 5.21 4.17
表3 AMI患者血清Hcy和部分炎症指标的变化
组别 n(例) HCY(μmol/L) hs-CRP(mg/L) IL-6(μg/L) IL-8(ng/L)
对照组 120 10.08±3.47 2.48±1.01 1.98±0.64 69.32±12.53
病例组 112 23.51±5.22b 18.72±4.55b 3.45±1.07a 198.85±23.65b
F值 3.21 5.46 7.14 11.58
图1 检测指标辅助诊断AMI的ROC曲线
表4 心肌损伤标志物和血液炎性因子的辅助诊断效能
AUC P值 95%CI 灵敏度（%) 特异度（%) 约登指数 临界值
CK-MB（μg/L) 0.788 0.000 0.672-0.887 97.1 52.9 0.500 0.88
cTnI（μg/L) 0.776 0.0001 0.658-0.868 73.5 100.0 0.735 1.08
MYO（μg/L) 0.941 0.000 0.856-0.984 82.4 100.0 0.824 54.87
BNP（ng/L) 0.934 0.000 0.847-0.980 88.2 94.1 0.824 510.00
NT-proBNP（ng/L) 0.979 0.000 0.911-0.999 94.1 100.0 0.941 605.00
IL-6（μg/L) 0.920 0.000 0.861~0.980 64.7 100.0 0.647 2.80
IL-8（ng/L) 0.908 0.000 0.822~0.995 88.2 100.0 0.882 102.00
hs-CRP（mg/L) 0.693 0.006 0.563~0.823 47.1 97.1 0.441 3.28
HCY（μmol/L) 0.998 0.000 0.994~1.003 100.0 97.1 0.971 11.56
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