Troponino T ir troponino I informatyvumas diagnozuojant ūminį miokardo infarktą

Abstract

Straipsnyje nagrinėjama troponino T ir troponino I tyrimų klinikinis specifiškumas bei jautrumas ligoniams, tiriamiems dėl įtariamo ūminio išeminio sindromo. Ištirti 87 ligoniai. Jiems atliktas klinikinis ištyrimas, užrašyta elektrokardiograma, nustatyta troponino T ir (ar) troponino I koncentracija kraujyje. Atsižvelgiant į troponinų testų gamintojų rekomendacijas, miokardo infarkto slenkstine diagnostine koncentracija laikytina troponino T 0,1 ng/ml arba didesnė, o troponino I 1,0 ng/ml arba didesnė. 60 ligonių buvo ištirta troponino T koncentracija. Šio tyrimo jautrumas, diagnozuojant ūminį miokardo infarktą, buvo 85 proc., specifiškumas – 87,2 proc. Troponino I tyrimas atliktas 46 ligoniams, jo jautrumas – 76 proc., specifiškumas – 76,2 proc. Ligoniams, kuriems atlikti abiejų troponinų tyrimai, nustatytas troponino T jautrumas buvo 100 proc., specifiškumas – 78 proc., troponino I atitinkamai – 86 ir 78 proc. Atlikus ROC (angl. receiver operator characteristic) analizę, nustatyta, kad bendras troponino T ir troponino I tyrimų tikslumas nustatant, kurie ligoniai serga ir kurie neserga ūminiu miokardo infarktu, statistiškai patikimai nesiskyrė. Pagal ROC analizę troponino T tyrimo didžiausias jautrumas ir specifiškumas, kai slenkstinė diagnostinė troponino T koncentracija buvo didesnė nei 0,04 ng/ml, o troponino I, kai troponino I slenkstinė koncentracija didesnė nei 0,69 ng/ml. In this article we investigate clinical specificity and sensitivity of cardiac troponin T and cardiac troponin I tests in the patients who were admitted to the hospital with suspected acute coronary syndrome. We investigated 87 patients: the clinical investigation was performed, electrocardiogram was recorded and concentrations of cardiac troponin T and troponin I were estimated. According to the recommendations of the manufacturers of troponin T and troponin I tests, threshold diagnostic troponin T concentration for myocardial infarction was considered ≥0.1 ng/ml and troponin I ≥1.0 ng/ml. Troponin T concentration was analyzed in 60 patients; the sensitivity of troponin T test in diagnosing acute myocardial infarction was 85%, and the specificity was 87.2%. Troponin I test was performed in 46 patients; the sensitivity of the test was 76% and the specificity was 76.2%. In case when both troponin T and I tests were performed, the sensitivity of troponin T was 100% and specificity was 78% and of troponin I – respectively 86% and 78%. According to the receiver operator characteristic analysis there was no significant difference between the general accuracy of troponin T and troponin I in distinguishing patients with and without acute myocardial infarction. According to the results of receiver operator characteristic analysis, the biggest clinical sensitivity and specificity were achieved when threshold myocardial infraction diagnostic concentration of troponin T was considered >0.04 ng/ml and of troponin I >0.69 ng/ml.