Foegh M L, Zhao Y, Madren L, Rolnick M, Stair T O, Huang K S, Ramwell P W
Department of Surgery, Georgetown University Medical Center, Washington, DC.
J Intern Med. 1994 Feb;235(2):153-61. doi: 10.1111/j.1365-2796.1994.tb01049.x.
The diagnosis of acute myocardial infarction (MI) is difficult in emergency rooms where large groups of patients present with chest pain. Confirmation of the diagnosis of MI based on the myocardial band of creatine phosphokinase may take a day. A more rapid diagnostic screening procedure is desirable and for this reason we evaluated urine thromboxane.
The study consisted of patients presenting with chest pain. Urine samples were obtained in the emergency room and on the following 5 days for those patients who were admitted to the hospital. The urine samples were used to determine the levels of immunoreactive 11-dehydro-thromboxane B2 (i-11-dehydro-TXB2) and 2,3-dinor-thromboxane B2 (i-2,3-dinor-TXB2). Myocardial infarction was defined as an increase in the myocardial band fraction of plasma creatine phosphokinase (> 5% of the total) and changes in the electrocardiogram. The patients' diagnoses were retrospectively correlated with thromboxane metabolite levels.
The present study took place in the emergency rooms of two major hospitals: Georgetown University Medical Center, Washington DC, and Fairfax Hospital, Virginia, USA.
The study comprised 369 patients presenting with acute chest pain and consisted of 247 men and 122 women aged 30-94 years.
The outcome measure of this study was the predictive value of i-11-dehydro TXB2 and i-2,3-dinor-TXB2, for the diagnosis of MI, in patients presenting in the emergency room with chest pain.
Patients undergoing an MI had significantly higher levels of both thromboxane metabolites in their urine in the emergency room, when compared to patients undergoing a cardiac event other than an MI or to patients with unstable angina. Thromboxane metabolite levels rapidly returned to normal on the days following admission to the hospital. Aspirin intake appeared to significantly decrease the levels of i-11-dehydro-TXB2, but not that of i-2,3-dinor-TXB2.
The measurement of thromboxane metabolites in the urine may provide a more rapid, accurate and cost-effective means of diagnosing MIs in patients presenting with chest pain.
在大量患者因胸痛前来就诊的急诊室中，急性心肌梗死（MI）的诊断颇具难度。基于肌酸磷酸激酶心肌带确认MI诊断可能需要一天时间。因此需要一种更快速的诊断筛查程序，为此我们对尿血栓素进行了评估。
该研究纳入了胸痛患者。在急诊室以及那些入院患者后续的5天内采集尿样。尿样用于测定免疫反应性11 - 脱氢 - 血栓素B2（i - 11 - 脱氢 - TXB2）和2,3 - 二去甲 - 血栓素B2（i - 2,3 - 二去甲 - TXB2）的水平。心肌梗死定义为血浆肌酸磷酸激酶心肌带分数增加（>总量的5%）以及心电图变化。对患者的诊断与血栓素代谢物水平进行回顾性关联分析。
本研究在两家大型医院的急诊室开展：美国华盛顿特区的乔治敦大学医学中心以及弗吉尼亚州的费尔法克斯医院。
该研究包含369例急性胸痛患者，其中男性247例，女性122例，年龄在30 - 94岁之间。
本研究的观察指标是i - 11 - 脱氢TXB2和i - 2,3 - 二去甲 - TXB2对急诊室胸痛患者MI诊断的预测价值。
与发生非MI心脏事件的患者或不稳定型心绞痛患者相比，发生MI的患者在急诊室时尿中两种血栓素代谢物水平显著更高。入院后数天，血栓素代谢物水平迅速恢复正常。服用阿司匹林似乎能显著降低i - 11 - 脱氢 - TXB2的水平，但对i - 2,3 - 二去甲 - TXB2水平无此作用。
测定尿中血栓素代谢物可能为诊断胸痛患者的MI提供一种更快速、准确且经济高效 的方法。
