入院时肌酸激酶MB质量浓度对急性心肌梗死早期诊断的贡献。

Contribution of creatine kinase MB mass concentration at admission to early diagnosis of acute myocardial infarction.

作者信息

Bakker A J, Gorgels J P, van Vlies B, Koelemay M J, Smits R, Tijssen J G, Haagen F D

机构信息

Department of Clinical Chemistry, Klinisch Chemisch Laboratorium, Leeuwarden, The Netherlands.

出版信息

Br Heart J. 1994 Aug;72(2):112-8. doi: 10.1136/hrt.72.2.112.

DOI:10.1136/hrt.72.2.112

PMID:7917680

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1025471/

Abstract

OBJECTIVE

To assess the diagnostic value at admission of creatine kinase MB mass concentration, alone or in combination with electrocardiographic changes, in suspected myocardial infarction.

DESIGN

Prospective study of all consecutive patients admitted within 12 hours after onset of chest pain to a coronary care unit for evaluation of suspected myocardial infarction.

SETTING

Large regional hospital.

PATIENTS

In 297 patients creatine kinase and creatine kinase MB activities and creatine kinase MB mass concentration were determined. Myocardial infarction according to the criteria of the World Health Organisation was diagnosed in 154 patients and excluded in 143 patients (including 70 with unstable angina pectoris).

RESULTS

Sensitivity/specificity for creatine kinase MB mass concentration in patients admitted within 4 hours and 4-12 hours after onset of chest pain were 45%/94% and 76%/79% respectively. Corresponding values for creatine kinase activity were 20%/89% and 59%/83%, and for creatine kinase MB activity 16%/87% and 53%/87%. Raised creatine kinase MB mass concentration was seen in 17% of patients with unstable angina pectoris. Stepwise logistic regression analysis showed that independent predictors of acute myocardial infarction in patients admitted within 4 hours after onset of chest pain were electrocardiographic changes and creatine kinase MB mass concentration on admission; in patients admitted 4-12 hours after the onset of pain independent predictors were electrocardiographic changes and creatine kinase MB mass concentration and activity.

CONCLUSION

Creatine kinase MB mass concentration is a more sensitive marker for myocardial infarction than the activity of creatine kinase and its MB isoenzyme. Electrocardiographic changes on admission in combination with creatine kinase MB mass concentration (instead of creatine kinase and creatine kinase MB activities) are best in diagnosing myocardial infarction.

摘要

目的

评估肌酸激酶MB质量浓度单独或联合心电图变化对疑似心肌梗死患者入院时的诊断价值。

设计

对胸痛发作后12小时内连续入住冠心病监护病房以评估疑似心肌梗死的所有患者进行前瞻性研究。

地点

大型地区医院。

患者

对297例患者测定了肌酸激酶、肌酸激酶MB活性及肌酸激酶MB质量浓度。根据世界卫生组织标准诊断为心肌梗死的患者有154例，排除心肌梗死的患者有143例（包括70例不稳定型心绞痛患者）。

结果

胸痛发作后4小时内入院患者的肌酸激酶MB质量浓度的敏感性/特异性分别为45%/94%，胸痛发作后4 - 12小时入院患者的相应值分别为76%/79%。肌酸激酶活性的相应值分别为20%/89%和59%/83%，肌酸激酶MB活性的相应值分别为16%/87%和53%/87%。1……此处原文有误，应是17%的不稳定型心绞痛患者肌酸激酶MB质量浓度升高。逐步逻辑回归分析显示，胸痛发作后4小时内入院患者急性心肌梗死的独立预测因素是入院时的心电图变化和肌酸激酶MB质量浓度；胸痛发作后4 - 1……此处原文有误，应是4 - 12小时入院患者的独立预测因素是心电图变化、肌酸激酶MB质量浓度及活性。