| Objective:Explore the application value of high-sensitivity troponin Ⅰ(hs-cTnⅠ)dynamic detection in the early diagnosis of patients with suspected myocardial infarction,and determine the diagnostic threshold of high-sensitivity troponin Ⅰin acute non-ST-segment elevation myocardial infarction.Methods:For patients with suspected myocardial infarction,dynamic detection of high-sensitivity troponin Ⅰat 0 hours and 3 hours,and troponin Ⅰat 0h and 6 hours.The patient’s medical history and clinical data are collected according to the routine diagnosis and treatment process,and the results of inspection and clinical judgments are analyzed and compared.Proportion and agreement rate of patients with moderate acute non-ST-segment elevation myocardial infarction,using receiver operating characteristic curve to analyze the diagnostic value of high-sensitivity troponin Ⅰdynamic detection for suspected acute myocardial infarction,to determine acute non-ST-segment elevation myocardium The diagnostic cut-off value of high-sensitivity troponin Ⅰfor infarction.Statistical analysis was performed using IBM SPSS 26.0 and Med Calc software.Results:(1)According to the fourth edition of the global unified definition of myocardial infarction,61 cases(29.19%)were clinically diagnosed as non-ST-segment elevation myocardial infarction,of which 72.13%(44 cases)were male.The initial concentration determination result in the test judgment:54 patients(25.84%)of non-ST-segment elevation myocardial infarction,and 58 patients(27.75%)of NSTEMI patients were grouped according to the gender of men and women;the result of the concentration difference determination was non-ST-segment elevation myocardium There were 55patients with infarction(26.32%).According to gender,60 patients with NSTEMI(28.71%).(2)The coincidence rate between the initial concentration and gender grouping test results and clinical judgment results are as high as 91.87%,the sensitivity is 88.52%and 95.08%,the specificity is 93.92%and 90.54%,and the positive predictive value(PPV)is respectively They were 85.70%and 80.60%,and the negative predictive value(NPV)was 95.20%and 97.80%,respectively.(3)The coincidence rates between the concentration difference and gender grouping test and clinical judgment results are as high as 94.26%and 95.69%.The sensitivity of the results of the concentration difference to determine the overall and gender grouping is 90.16%and 98.36%,the specificity is 95.95%and 81.08%,the PPV is 90.20%and 68.20%,and the NPV is 95.90%and 99.20%.(4)The initial diagnostic threshold of hs-c Tn I for diagnosis of non-ST-segment elevation myocardial infarction is 33.37ng/L,the area under the curve(AUC)is 0.961(95%CI:0.935～0.987),and the Youden index is 0.824;male Diagnostic cut-off value:32.85ng/L,sensitivity is97.83%,specificity is 95.10%,AUC of 0.986(95%CI:0.969 to 1.000),Youden index 0.929;female diagnostic cut-off value:26.66ng/L,sensitivity is 86.67%,The specificity is80.43%,the AUC is 0.890(95%CI:0.803 to 0.976),and the Youden index is 0.671.(5)The diagnostic cut-off value of hs-c Tn I concentration difference for diagnosis of non-ST-segment elevation myocardial infarction is 34.40ng/L,AUC is 0.962(95%CI:0.934～0.990),Youden index is 0.861;male diagnostic cut-off value:32.90ng/L,sensitivity is95.65%,specificity is 93.33%,AUC:0.980(95%CI:0.955 to 1.000),Youden index is0.908;female diagnostic threshold:16.13ng/L,sensitivity is 93.48%,specificity is 80.00%,AUC is 0.928(95%CI:0.859～0.997),Youden index is 0.928.Conclusion:(1)The dynamic detection of high-sensitivity troponin Ⅰ in the diagnosis of acute non-ST-segment elevation myocardial infarction is feasible and accurate in clinical diagnosis and treatment.(2)This study determined the initial concentration of high-sensitivity troponin Ⅰand the diagnostic cut-off value of the concentration difference in acute non-ST-segment elevation myocardial infarction,and the diagnostic efficacy of the concentration difference may be better than the initial concentration,or it may become a better diagnosis for NSTEMI in the future It is an accurate indicator.(3)There are gender differences in the detection of high-sensitivity troponin I.Males are higher than females.The introduction of this gender grouping can improve the diagnosis rate of NSTEMI,which may enable us to more reliably and early risk stratification of people with suspected myocardial infarction,Identify high-risk groups and guide clinical strategies. |
PDF Full Text Request