目的  探讨血清肌酸激酶同工酶（ceatine kinase isoenzyme, CK-MB）、心肌肌红蛋白（myoglobin, MYO）以及血栓弹力图（thrombelastogram, TEG）指标$$凝血反应时间（R）、血液凝固时间（K）、凝固角、最大血块强度（maximalamplitude,MA）$$与急性心肌梗死（acute myocardial infarction, AMI）严重程度的相关性，以及上述指标联合检测对AMI患者发生主要不良心血管事件（major adverse cardiovascular events, MACE）的预测价值。方法  选取117例AMI患者作为AMI组，另选取同期健康体检者110例作为对照组。根据Killip分级将AMI患者分成4级；根据治疗后一年内有无发生MACE，将AMI患者分为发生MACE及未发生MACE亚组。对比AMI组和对照组，以及不同Killip分级AMI患者入院时血清CK-MB、MYO水平及TEG指标R、K、凝固角、MA，并分析上述指标与Killip分级的相关性。对比发生MACE及未发生MACE亚组患者入院时血清CK-MB、MYO水平及TEG指标R、K、凝固角、MA，通过ROC曲线分析上述指标联合检测对AMI患者发生MACE的预测价值。结果  AMI组入院时血清CK-MB、MYO水平及TEG指标凝固角、MA均高于对照组，TEG指标R、K均低于对照组（P＜0.05）。不同Killip分级患者血清CK-MB、MYO及TEG指标凝固角、MA比较：Ⅳ级＞Ⅲ级＞Ⅱ级＞Ⅰ级（P<0.05）。TEG指标R、K水平比较：Ⅰ级＞Ⅱ级＞Ⅲ级＞Ⅳ级（P＜0.05）。血清CK-MB、MYO及TEG指标凝固角、MA与Killip分级呈正相关，TEG指标R、K与Killip分级呈负相关（P＜0.05）。发生MACE亚组患者入院时血清CK-MB、MYO及TEG指标凝固角、MA均高于未发生MACE亚组患者，TEG指标R、K均低于未发生MACE亚组患者（P＜0.05）。入院时血清CK-MB、MYO水平及TEG指标R、K、凝固角、MA联合检测预测AMI患者发生MACE的AUC值为0.895，敏感性为83.17%，明显高于上述指标单独检测（P＜0.01）。结论  血清CK-MB、MYO与TEG指标R、K、凝固角、MA水平可用于评估AMI的严重程度，与Killip分级具有显著相关性，且上述指标联合检测对预测AMI患者发生MACE具有较高的诊断效能。

 Objective  To investigate the correlation of serum ceatine kinase isoenzyme (CK-MB), myocardial myoglobin (MYO) levels, and thrombelastogram (TEG) indexes[coagulation reaction time (R), blood coagulation time (K), Angle and maximal amplitude (MA) ] with the severity of acute myocardial infarction (AMI). To explore the value of the combined detection of the above indexes in predicing major adverse cardiovascular events (MACE) among patients with AMI. Methods  A total of 117 patients with AMI were selected as AMI group while another 110 healthy physical examinees during the same period were selected as control group. AMI patients were divided into 4 classes according to Killip classification. According to the presence or absence of MACE within one year after treatment, AMI patients were divided into MACE and non-MACE subgroups. The serum CK-MB and MYO levels, and TEG indexes of R, K, Angle and MA at admission were compared between AMI group and control group, and among AMI patients with different Killip classes, respectively. The correlation of the above indexes with Killip classes was analyzed. The serum levels of CK-MB and MYO, and TEG indexes of R, K, Angle and MA at admission were compared between MACE and non-MACE subgroups. ROC curve was utilized to analyze the predictive value of the combined detection of the above indexes on the occurrence of MACE in AMI patients. Results  The serum levels of CK-MB and MYO, and TEG indexes of Angle and MA in the AMI group were all higher than those in the control group while TEG indexes of R and K were both lower than those in the control group (P<0.05). The serum levels of CK-MB and MYO, and TEG indexes of Angle and MA were compared among the AMI patients with different Killip classes: Class Ⅳ> Class Ⅲ>Class Ⅱ> Class Ⅰ(P<0.05). The TEG indexes of R and K were also made comparison: Class Ⅰ>Class Ⅱ>Class Ⅲ>Class Ⅳ (P<0.05). Serum levels of CK-MB and MYO, and TEG indexes of Angle and MA were positively correlated with Killip classification while TEG indexes of R and K were negatively correlated with Killip classification (P<0.05). At admission, the serum levels of CK-MB and MYO, and TEG index of Angle and MA in the MACE subgroup were all higher than those in the non-MACE subgroup; the TEG indexes of R and K were both lower than those in the non-MACE group (P<0.05). The AUC and sensitivity of the combined detection of serum levels of CK-MB and MYO, and TEG indexes of R, K, Angle and MA at admission for predicting MACE in AMI patients were 0.895 and 83.17%, respectively, which were significantly higher than those of any of the above indexes alone (P<0.01). Conclusion  Serum levels of CK-MB and MYO, and TEG indexes of R, K, Angle and MA can be used to evaluate the severity of AMI. These indexes are significantly correlated with Killip classification. The combined detection of the above indexes has a high diagnostic efficacy in predicting the occurrence of MACE in AMI patients.