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目的探讨肌红蛋白(MYO)检测在急性冠状动脉综合征(ACS)发病早期诊断和溶栓再通效果监测的应用价值。方法应用免疫比浊法检测胸痛患者入院即刻血浆中的MYO、肌钙蛋白T(cTnT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)含量并比较其在不同时点的敏感度、特异度、阳性预测值、阴性预测值。对实施冠状动脉造影的病例观察其冠状动脉病变的严重程度与MYO的相关性。观察MYO在溶栓前后的变化。结果入院即刻心梗组的MYO、cTnT、CK、CK-MB分别为(56±34)μg/L,(0．05±0．03)μg／L,(94±84)U／L,(17±13)U／L,均高于健康对照组(P<0．05),并且Q波心梗组(263±182)μg／L明显高于非Q波心梗组(165±102)μg／L,P<0．01。不稳定性心绞痛组的MYO(56．48±33．59)μg／L高于健康对照组(P<0．01),不稳定性心绞痛组CK、CK-MB与健康对照组比较差异无统计学意义(P>0．05)。MYO在胸痛发作8 h时敏感度最高,特异度在发病24 h内高于cTnT(P<0．01),与CK-MB差异无统计学意义(P>0．05)。MYO和CK-MB的阳性预测值在发病24 h内均高于cTnT,阴性预测值在4 h MYO高于cTnT和CK-MB(P<0．01)。冠状动脉造影多支病变组的MYO含量(167±72)μg／L高于单支和早期病变组(P<0．01),早期病变组与单支组差异无统计学意义(P>0．05)。MYO在溶栓术后在血浆中含量明显升高,酶峰出现在5．26 h,比CK、CK-MB明显提前(P<0．01)。结论MYO是一个灵敏、可靠的早期诊断ACS和监测溶栓疗效的指标,联合CK、CK-MB、cTnT测定更有意义。
Objective To investigate the value of myoglobin (MYO) detection in the early diagnosis of acute coronary syndrome (ACS) and the monitoring of the effect of thrombolytic recanalization. Methods The contents of MYO, cTnT, CK and CK-MB in plasma of patients with chest pain immediately after admission were detected by immunoturbidimetry and compared at different time points The sensitivity, specificity, positive predictive value, negative predictive value. On the implementation of coronary angiography in patients with coronary artery lesions severity and MYO correlation. To observe the change of MYO before and after thrombolysis. Results The MYO, cTnT, CK and CK-MB in myocardial infarction group were (56 ± 34) μg / L and (± 0.05 ± 0.03) μg / L and (94 ± 84) U / 17 ± 13) U / L were significantly higher than those in the healthy control group (P <0.05), and the Q wave myocardial infarction group (263 ± 182) μg / L was significantly higher than the non Q wave myocardial infarction group (165 ± 102) μg / L, P <0.01. The MYO (56.48 ± 33.59) μg / L in unstable angina group was higher than that in healthy control group (P <0.01). There was no statistic difference between CK and CK-MB in unstable angina group and healthy control group Significance (P> 0.05). MYO had the highest sensitivity at 8 h after onset of chest pain. The specificity of MYO was higher than that of cTnT within 24 h of onset (P <0.01), but no significant difference with CK-MB (P> 0.05). The positive predictive values of MYO and CK-MB were all higher than cTnT within 24 hours of onset, while the negative predictive values of MYO and CK-MB were higher than cTnT and CK-MB at 4 hours (P <0.01). The MYO content in the multi-vessel lesion group (167 ± 72 μg / L) was significantly higher than that in the single vessel group and the early lesion group (P <0.01), but there was no significant difference between the early lesion group and the single vessel group (P> 0 .05). The content of MYO in plasma increased significantly after thrombolytic therapy. The peak of enzyme appeared at 5.26 h, which was significantly earlier than CK and CK-MB (P <0.01). Conclusion MYO is a sensitive and reliable early diagnosis of ACS and indicators of thrombolytic therapy efficacy, combined with CK, CK-MB, cTnT determination more meaningful.