摘要目的:探讨HEART评分联合心肌梗死三项床旁检测在急诊胸痛患者诊断中的价值。方法:回顾性选取2018年1月至2018年12月在廊坊市人民医院就诊的急诊胸痛患者310例，入院时均进行了HEART评分评估，并检测了血清肌酸激酶同工酶(CK-MB)、肌红蛋白(Myo)及肌钙蛋白I(cTnI)水平。结果:310例患者中，最终确诊为心源性胸痛患者232例，非心源性胸痛患者78例；心源性胸痛中，急性冠脉综合征患者151例，稳定型心绞痛患者81例；心源性胸痛患者HEART评分、CK-MB、Myo及cTnI分别为(5.00±1.01)分、(14.45±3.11)ng/ml、(60.20±11.34)ng/ml和(2.30±0.89)ng/ml，明显高于非心源性胸痛患者( P<0.05)；急性冠脉综合征患者HEART评分、CK-MB、Myo及cTnI分别为(5.83±1.12)分、(16.02±2.88)ng/ml、(64.49±12.01)ng/ml和(2.54±0.91)ng/ml，明显高于稳定型心绞痛患者( P<0.05)；HEART评分联合心肌梗死三项诊断心源性胸痛的ROC曲线下面积为0.811( P<0.05)，高于各指标单一诊断，灵敏度和特异度分别为85.28%和82.50%；HEART评分联合心肌梗死三项诊断急性冠脉综合征的ROC曲线下面积为0.901( P<0.05)，高于各指标单一诊断，灵敏度和特异度分别为90.00%和85.00%；急性冠脉死亡患者HEART评分为(6.88±1.02)分，明显高于存活患者( P<0.05)；HEART评分预测急性胸痛患者预后死亡的ROC曲线下面积为0.674( P<0.05)，截断值为6分时，灵敏度和特异度分别为78.00%和70.00%；心源性胸痛患者随着危险程度升高，CK-MB、Myo和cTnI升高( P<0.05)。 结论:HEART评分联合心肌梗死三项床旁检测在急诊胸痛中有较好的应用价值，值得临床使用。

abstractsObjective:To explore the value of HEART score combined with three bedside tests of myocardial infarction in the diagnosis of emergency chest pain patients.Methods:310 patients with emergency chest pain treated in Langfang People's Hospital from January 2018 to December 2018 were retrospectively selected. The HEART score was evaluated at admission, and the levels of serum creatine kinase isoenzyme (CK-MB), myoglobin (Myo) and troponin I (cTnI) were detected.Results:Among 310 patients, 232 cases were diagnosed as cardiogenic chest pain, 78 cases were non cardiogenic chest pain; In cardiogenic chest pain, 151 cases were acute coronary syndrome and 81 cases were stable angina pectoris; The HEART score, CK-MB, Myo and cTnI in patients with cardiogenic chest pain were (5.00±1.01)points, (14.45±3.11)ng/ml, (60.20±11.34)ng/ml and (2.30±0.89)ng/ml, respectively, which were significantly higher than those in patients with non cardiogenic chest pain ( P<0.05); The HEART score, CK-MB, myo and cTnI in patients with acute coronary syndrome were (5.83±1.12), (16.02±2.88)ng/ml, (64.49±12.01)ng/ml and (2.54±0.91)ng/ml, which were significantly higher than those in patients with stable angina pectoris ( P<0.05); The area under receiver operating characteristic (ROC) curve of HEART score combined with myocardial infarction in the diagnosis of cardiogenic chest pain was 0.811 ( P<0.05), which was higher than single diagnosis of other indexes; the sensitivity and specificity were 85.28% and 82.50% respectively; The area under ROC curve of HEART score combined with myocardial infarction in the diagnosis of acute coronary syndrome was 0.901 ( P<0.05), which was higher than single diagnosis of other indexes; the sensitivity and specificity were 90.00% and 85.00% respectively; The HEART score of patients with acute coronary death was (6.88±1.02), which was significantly higher than that of patients with survival ( P<0.05); The area under ROC curve predicted by HEART score was 0.674 ( P<0.05). When the cut-off value was 6, the sensitivity and specificity were 78.00% and 70.00%, respectively; the CK-MB, Myo and cTnI increased with the risk of cardiogenic chest pain ( P<0.05). Conclusions:HEART score combined with three bedside tests of myocardial infarction has a good application value in the emergency chest pain, which is worthy of clinical use.