【摘要】 目的　比较研究心肌肌钙蛋白I和T对急性心肌梗塞 (AMI)的临床诊断应用价值。方法　采用前瞻性双盲随机及平行对照试验方法 ,将研究对象分为AMI组和非AMI组。AMI组共有按WHO标准诊断的AMI病人 12 1例 ,随机分二组分别作肌钙蛋白I(cTnI)和肌钙蛋白T(cTnT)检查。作cTnI的共 6 2例 ,作cTnT的 5 9例。非AMI组包括健康人 80例及陈旧心肌梗死、心绞痛、肾衰等患者。本法采用单克隆抗体酶联免疫法检测。cTnI和cTnT的正常值均为 0 .2mg/L。CK MB正常为 2 5U/L。结果　在AMI早期cTnI诊断敏感性较cTnT为高 ,胸痛 2h阳性率分别为 41.7%和 0 .0 % (P <0 .0 1)。在AMI中晚期则cTnI较cTnT为低 ,AMI第 10d阳性率分别为 38.7%和 6 2 .7% (P <0 .0 5 )。连续检测两者敏感性均可达 10 0 %(AMI 8～ 12h)。各期敏感性均优于CK MB。在非AMI组cTnT可出现在肾衰病人。cTnI、cTnT和CK MB诊断AMI特异性无明显差异 (P >0 .0 5 )。cTnI和cTnT有较高的阴性预测值 ,它们均可达 10 0 %。血管再通和梗塞部位及有无Q波影响它们在AMI早期的敏感性。结论　cTnI和cTnT是诊断AMI的敏感指标。在AMI早期检测cTnI而中晚期检测cTnT可提高AMI的诊断阳性率。更多还原

【Abstract】 Objective To compare the value between cardiac troponin I (cTnI) and T (cTnT) for detection of acute myocardial infarction(AMI). Methods In this prospective, double blind, randomized, parallel controlled study, the subjects were divided into two: AMI group and non AMI group. There were 121 patients with AMI(WHO Criteria). Serum cTnI and cTnT were measured randomly in the two groups. cTnI in 62 patients with AMI and cTnI in 59 patients with AMI were measured. Non AMI group included 80 normal subjects, patients with old myocardial infarction, angina pectoris, renal failure and so on. The monoclonal enzyme immunoassay test was used. The normal range for both cTnI and cTnT was 0.2 mg/L and for creatine kinase isoenzyme MB(CK MB) was 25 U/L. Results The sensitivity of cTnI was higher in early period and that of cTnT was better in late period. Sensitivity of cTnI and cTnT was 41.7% and 0.0% (P <0.01) respectively at h 2 after chest pain. It was 38.7% and 62.7% ( P <0.05) at d 10 of AMI. Sensitivity of cTnI and cTnT could reach 100% after serial assays (at h 8～10 after AMI) and both were better than CK MB. In a few patients with angina pectoris in non AMI group, cTnI and cTnT were positive and these were positive in patients with renal failure. There was no significant difference of the specificity among cTnI, cTnT and CK MB for detection of AMI. Both cTnI and cTnT had higher negative prospective values (to 100%). There were effects of reperfusion and side of infarction and non Q infarction on their sensitivity in early period of AMI. Conclusion Test of both cTnI and cTnT were the sensitive methods. The results indicate that sensitivity for diagnosis of AMI can be increased if cTnI is tested in early AMI and cTnT in middle and late AMI.更多还原