【摘要】 目的评价心电图、心肌损伤标志物及传统冠心病(CHD)危险因素在急性冠脉综合征(ACS)早期诊断中的价值。方法急性胸痛患者139例,冠状动脉造影明确冠状动脉情况,同时收集患者心电图、心肌损伤标志物及伴有的危险因素(吸烟、肥胖、高血脂、高血压、糖尿病)。根据上述资料将患者分为四组:A组36例,患者有症状,心电图有异常表现,且心肌损伤标志物异常;B组50例,患者有症状,心电图有异常表现,但心肌损伤标志物无异常;C组23例,患者有症状,但胸痛发作时心电图无明显改变,患者有>2个危险因素;D组30例,患者有症状,但胸痛发作时心电图无明显改变,患者有≤2个危险因素。比较各组患者ACS的发生率。结果 139例中,心肌梗死患者45例,不稳定性心绞痛患者65例,非心源性胸痛(NCCP)患者29例。A、B、C和D组ACS发生率分别为100.0%、84.0%、69.6%和53.3%。联合心电图及心肌损伤标志物诊断ACS的敏感性为73.6%,特异性为91.0%。结论心电图及心肌损伤标志物在ACS早期诊断中具有较高的特异性,但敏感性较低。对于心电图及心肌损伤标志物均正常的患者,合并危险因素数量在ACS早期诊断中价值不大。更多还原

【Abstract】 Objective To evaluate ECG,cardiac injury markers and the traditional risk factors for coronary heart disease(CHD)in the early diagnosis of acute coronary syndrome(ACS).Methods Data of 139 patients with acute chest pain were collected and analyzed,which included coronary angiography,ECG,cardiac injury markers and traditional risk factors for CHD.Based on these,the patients were assigned into four groups of A(36 cases with acute chest pain,ECG change and abnormal cardiac injury biomarkers),B(50 cases with acute chest pain and ECG change without abnormal cardiac injury biomarkers),C(23 cases with acute chest pain,normal ECG,normal cardiac injury biomarkers and more than 2 traditional risk factors),and D(30 cases with acute chest pain,normal ECG and normal cardiac injury biomarkers,but only≤2 traditional risk factors).The incidence of ACS was compared among 4 groups.Results Of 139 patients with acute chest pain,45 cases were diagnosed as myocardiac infarction,65 cases as unstable angina and 29 cases as noncardiac chest pain.The incidence rates of ACS were 100.0%,84.0%,69.6% and 53.3% for groups of A,B,C and D,respectively.Combined analysis of ECG and cardiac injury markers showed a sensibility of 73.6% and specificity of 91.0%。Conclusion ECG and cardiac injury markers have a high specificity,but a low sensibility in the early diagnosis of ACS.In the patients with normal ECG and cardiac injury markers,the number of traditional risk factors for CHD has no much significance in the early diagnosis of ACS.更多还原