Diagnostic efficacy of rapid detection of high-sensitivity troponin in the early stages of acute myocardial infarction in the elderly patients
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摘要: 目的 观察现场快速检测高敏肌钙蛋白I(hs-cTnI)在急诊老年胸痛患者人群中的表达情况，并评价其对急性心肌梗死(AMI)的诊断效能。方法 选择2018年6月—2021年5月期间我院急诊科收治的胸痛疑似急性冠脉综合征(ACS)而行现场快速检测hs-cTnI的315例老年患者作为研究对象，观察hs-cTnI在老年急性胸痛患者中的表情况。以心内科专家根据患者临床资料并结合后期相关检查结果作出的最后判断为标准，计算初次hs-cTnI诊断老年AMI的敏感度和特异度，绘制受试者工作特征(ROC)曲线判断hs-cTnI对老年AMI的诊断价值，并计算出其最佳临界值。结果 315例老年急性胸痛患者中，最终经临床判定为AMI的患者93例(29.5%)，非AMI患者222例(70.5%)。AMI患者hs-cTnI总体表达水平显著高于非AMI组[(1.150±0.710)ng/mL vs.(0.045±0.014) ng/mL，P< 0.001]。ROC曲线分析显示，曲线下面积(AUC)为0.928(95%CI：0.886~0.969)，此时hs-cTnI的截断值(Cut-off)为0.339 ng/mL，相应的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)分别为88.3%、96.3%、92.1%和96.1%。结论 初次现场快速检测hs-cTnI对老年AMI有着较好的诊断效能，针对本地区老年人群AMI早期诊断最佳临界值为0.339 ng/mL，在基层医院急诊AMI鉴别诊断中有着较高的准确性和较强的可操作性。Abstract: Objective To observe the expression of high-sensitivity troponin I(hs-cTnI) by point-of-care testing(POCT) in the elderly patients with chest pain, and evaluate its diagnostic efficacy for acute myocardial infarction(AMI).Methods A total of 315 elderly patients with acute chest pain who were suspected of acute coronary syndrome(ACS) in the emergency department of our hospital from June 2018 to May 2021 were selected as the research objects to observe the expression of hs-cTnI. The sensitivity and specificity of primary hs-cTnI in elderly patients with AMI were calculated on the basis of the final judgment made by cardiologic experts according to the clinical data of patients and the results of related examinations. The receiver operating characteristic (ROC) curve was drawn to determine the diagnostic value of hs-cTnI in elderly patients with AMI, and the best diagnostic value was calculated.Results Among the 315 elderly patients with acute chest pain, 93 patients(29.5%) were finally clinically determined to be AMI patients, and 222 patients(70.5%) were non-AMI patients. The overall expression level of hs-cTnI in AMI patients was significantly higher than that in non-AMI patients[(1.150±0.710) ng/mL vs. (0.045±0.014) ng/mL,P< 0.001]. ROC curve analysis showed that the area under the curve(AUC) was 0.928(95%CI: 0.886-0.969), and the cut-off value(Cut-off) of hs-cTnI was 0.339 ng/mL, corresponding sensitivity, specificity, positivity predictive value(PPV) and negative predictive value(NPV) were 88.3%, 96.3%, 92.1%, and 96.1%, respectively.Conclusion The first hs-cTnI of POCT has good diagnostic efficiency for elderly AMI. The best cut-off value for early diagnosis of AMI in the elderly population in this region is 0.339 ng/mL, which has high accuracy and good operability in the differential diagnosis of AMI in the emergency department of the primary hospital.
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Key words:
- high-sensitivity troponin I /
- elderly patient /
- chest pain /
- acute myocardial infarction
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表 1 AMI患者和非AMI患者就诊时一般情况比较
X±S，例(%) 组别 AMI患者(n=93) 非AMI患者(n=222) t/χ2 P 男性 68(73.1) 113(50.9) 13.236 ＜0.001 年龄/岁 71.5±8.3 65.3±4.9 8.229 ＜0.001 心率/(次·min-1) 89.5±10.5 75.6±8.3 12.5 ＜0.001 平均动脉压/mmHga) 107.5±11.5 109.0±13.3 0.949 0.343 HEART评分/分 6.9±1.4 4.8±1.0 15.014 ＜0.001 长期吸烟史 30(32.3) 62(27.9) 0.594 0.441 酗酒 20(21.5) 32(14.4) 2.391 0.122 ACS史 29(31.2) 20(9.0) 24.533 ＜0.001 高血压史 56(60.2) 125(56.3) 0.41 0.522 糖尿病史 28(30.1) 50(22.5) 2.024 0.155 高血脂史 48(51.6) 110(49.5) 0.112 0.738 脑卒中史 5(5.4) 11(5.0) 0.024 0.877 慢性肾功能不全 3(3.2) 2(0.9) 1.024 0.312b) 心力衰竭 1(1.1) 0(0.0) 0.202 0.653b) 注：a)1 mmHg=0.133 kPa；b)使用连续性校正的χ2检验。 
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