诊断标记合作研究用于诊断心肌梗塞
J Zimmerman1, R Fromm, D Meyer
1General Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.
Circulation
|April 6, 1999
概括
诊断胸部疼痛是一项挑战. 肌酸激酶-MB (CK-MB) 亚型和肌球蛋白对早期检测最敏感,而CK-MB活性和热素I对晚期诊断最好.
科学领域:
- 心脏病学 心脏病学
- 临床诊断 临床诊断 临床诊断
- 生物标志物研究 生物标志物研究
背景情况:
- 胸痛是急诊室常见的投诉,心肌梗塞 (MI) 仅在10-15%的病例中出现.
- 目前用于心脏病发作的诊断标志物缺乏足够的灵敏度和特异性,导致治疗延迟和不必要的住院治疗.
- 关于新型心脏生物标志物的比较数据很少,但利用所有可用的标志物是不切实际的和昂贵的.
研究的目的:
- 为了比较各种心脏生物标志物的诊断性能,用于胸痛评估.
- 为了确定肌酸激酶-MB (CK-MB) 亚型,肌红蛋白,总CK-MB,热素T和热素I的敏感性和特异性.
- 评估这些标记物在识别心肌梗塞和不稳定性胸痛中的有用性.
主要方法:
- 一项前性,多中心,双盲研究,招募955名胸痛患者.
- 对生物标记物的连续采样 (CK-MB亚型,肌球蛋白,总CK-MB,托罗邦素T,托罗邦素I) 长达24小时.
- 在患有不稳定性胸痛的患者中,分析诊断灵敏度,特异性和标志物升高频率.
主要成果:
- CK-MB亚型在症状出现6小时内表现出最高的敏感性 (91%) 和特异性 (89%).
- 肌球蛋白在早期诊断中也具有高度敏感性和特异性 (78%和89%).
- 对于晚期诊断 (10-18小时),总CK-MB活性 (96%的灵敏度,98%的特异性) 和素I (96%的灵敏度,93%的特异性) 显示出优异的性能.
结论:
- 单独使用CK-MB亚型试验或与热波结合使用,可可靠地对胸痛患者进行分类.
- 这种方法有可能改善患者治疗并降低医疗保健成本.
- 对心脏事件的早期和准确诊断对于有效的管理至关重要.
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