降钙素原评价急性冠脉综合征的临床研究-东南大学学报医学版

降钙素原评价急性冠脉综合征的临床研究

单位：1. 承德市双滦区人民医院心内科, 河北承德 067101;
2. 承德护理职业学院, 河北承德 067000;
3. 承德市双滦区人民医院急诊科, 河北承德 067101

分类号：R514.4

出版年·卷·期（页码）：2014·33·第三期（287-290）

摘要：

目的：探讨降钙素原（PCT）评价急性冠脉综合征的临床意义。方法：通过对急诊141例缺血性胸痛患者进行心肌标志物的测定，观察患者心脏不良事件（MACE）发生率及死亡率，并进一步比较PCT与其他心肌标志物，如肌钙蛋白T（Tn-T）、肌酸磷酸激酶同工酶（CK-MB）、肌红蛋白及超敏C反应蛋白（Hs-CRP）在评价急性冠脉综合征中的临床意义。结果：PCT诊断心肌梗死敏感性为38.3%（95%CI 28.8%~47.3%），特异性为77.8%（95%CI 70.0%~84.4%），阳性似然比1.725，阴性似然比0.792；复测PCT敏感性、特异性、LR（+）及LR（-）分别为90.0%（95%CI 80.9%~95.7%）、59.3%（95%CI 52.5%~63.5%）、2.2及0.16。PCT评价MACE、住院期间死亡率及自入院后1个月内、6个月内的死亡率敏感性及特异性分别为81.3%（95%CI 54%~95%）/40.8%（95%CI 32%~49%）、66.7%（95%CI 13%~98%）/38.4%（95%CI 30%~47%）、50%（95%CI 9%~90%）/38%（95%CI 30%~47%）、60%（95%CI 17%~92%）/38.2%（95%CI 30%~47%）。结论：对以缺血性胸痛为主要表现的患者来说，PCT不是诊断急性冠脉综合征有效的标志物，且对心肌梗死预后无准确的评价意义。

Objective:To investigate the evaluation effect of procalcitonin(PCT) on acute coronary syndrome. Methods:141 patients with chemic chest pain in the emergency department were chosen to test the cardiac markers, and evaluate the incidence of adverse cardiac events and mortality rate. Furthermore, the clinical significances of PCT were compared with other cardiac markers (Tn-T, CK-MB, myoglobin and Hs-CRP) in the evaluation of acute coronary syndrome. Results:PCT to identify myocardial infarction in patients with chest pain of presumed ischemic origin had a sensitivity of 38.3% (95%CI 28.8%-47.3%) and a specificity of 77.8% (95%CI 70.0%-84.4%), a positive likelihood ratio (LR+) of 1.725 and a negative likelihood ratio (LR-) of 0.792. The 4th hour diagnostic values (sensitivity, specificity, LR+and LR-) of procalcitonin were 90% (95%CI 80.9%-95.7%), 59.3% (95%CI 52.5%-63.5%), 2.2, and 0.16, respectively. Sensitivity and specificity of PCT in evaluating MACE and hospital, after 1 month, 6 month mortality were 81.3% (95%CI 54%-95%) /95%(95%CI 32%-49%), 95%(95%CI 13%-98%) /38.4%(95%CI 30%-47%),47%(95%CI 9%-90%) /38%(95%CI 30%-47%),47%(95%CI 17%-92%) /38.2%(95%CI 30%-47%). Conclusion:For patients with chemic chest pain as the main performance, PCT is not an effective marker of myocardial infarction, and no sense of accurate evaluation of the prognosis of myocardial infarction.

参考文献：

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