摘要
目的:探讨心脏型脂肪酸结合蛋白(H-FABP)在早期诊断急性心肌梗死(AMI)方面的价值。方法:连续检测发病6h内入院的胸痛患者104例,所有病例均于入院即刻采用H-FABP快速诊断试纸进行定性检测,同时测定患者血清心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)水平,比较上述4种心肌损伤标志物在诊断AMI方面的敏感性和特异性。结果:入选患者中最终确诊AMI者51例,非心肌梗死者53例,其中不稳定型心绞痛(UAP)17例,稳定型心绞痛(SAP)16例,非心源性胸痛者(NCCP)20例。参照标准诊断,H-FABP、MYO、CK-MB和cTnT检出AMI的敏感性分别为86.27%,68.63%,47.06%和47.06%,H-FABP显著高于后3者(P均<0.05);检测特异性分别为84.90%,84.90%,96.23%和98.11%,H-FABP的特异性较cTnT差(P<0.05),而与MYO、CK-MB无显著差异。对于胸痛发生3h内的患者,H-FABP、MYO、CK-MB和cTnT诊断AMI的敏感性依次为79.17%,58.33%,37.50%和33.33%;对于胸痛发生3～6h的患者,相应的检出敏感性分别为92.59%,77.78%,55.56%和59.26%;在上述2种时间段HFABP的敏感性均显著高于CK-MB和cTnT(P均<0.05)。在胸痛6h内,H-FABP联合cTnT检出AMI的敏感性为92.16%,显著高于MYO、CK-MB和cTnT三者联合检测的敏感性76.47%,(P<0.05),而2种组合的检测特异性无显著差异。结论:H-FABP快速定性检测试剂盒使用简便快捷,在AMI早期(发病≤6h)具有更高的诊断价值;H-FABP与cTnT联合用于AMI的诊断可进一步提高检测敏感性,且保持较高的特异性,优于传统的MYO、CK-MB与cTnT3项组合。
Objective： To evaluate the efficacy of heart-type fatty-acid binding protein （H-FABP） for early diagnosis of AML Methods： One hundred and four consecutive patients admitted to the hospital within 6 h after the onset of chest pain were recruited in the study. A rapid test kit for qualitative determination of H-FABP was applied to detect the whole serum H-FABP level in all patients at the time of admission. Serum troponinT （cTnT）, ereatine kinase-myocardial band（CK-MB）, and myoglobin（MYO） were also measured simultaneously. Results：Among 104 recruited patients, 51 had a final diagnosis of AMI,and 53 were excluded from AMI, among whom 17 were diagnosed as UAP, 16 as SAP, and 20 as non-cardiogenic chest pain. By comparing the results of the biochemical tests with the standard diagnosis,the sensitivity of H-FABP,MYO,CK-MB and cTnT in diagnosis of AMI were 86.27%, 68.63%, 47.06% and 47.06% respectively. The sensitivity of H-FABP was significantly higher than that of MYO, CK-MB and cTnT （P 〈 0.05 for all）. In terms of specificity, the numbers are 84.90%, 84.90%, 96.23% and 98.11% respectively. The specificity of H-FABP was lower than that of cTnT（P 〈 0.05）, but there was no significant difference between H-FABP and MYO or CK-MB; Within 3 hours after the onset of symptome appearance, the respective sensitivity of H-FABP,MYO,CK-MB and cTnT in diagnosis of AMI was 79.17% , 58.33%, 37.50% and 33.33%;Within 3-6 hours, the respective sensitivity was 92.59%,77.78%, 55.56% and 59.26%. In both of the two time stage , the sensitiviy of H-FABP were significantly higher than that of CK-MB and cTnT （both P 〈 0.05） ; Within 6 hours after the onset of chest pain, the sensitivity of H-FABP ＋ cTnT was significantly higher than that of MYO＋CK-MB ＋ cTnT （92.16% vs 76.47%, P 〈 0.05）, but the differences between the specificity of the two were not statistically significant. Conclusion： The rapid qualitative H-FABP test kit has high efficacy in the diagnosis of AMI as early as within 6 hours of symptom onset. Combining H-FABP and cTnT provides higher sensitivity than the MYO, CK-MB and cTnT combination in the diagnosis of earlv AMI.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2009年第8期1133-1137,1163,共6页
Journal of Nanjing Medical University(Natural Sciences)
基金
霍英东教育基金会第十届高等院校青年教师基金(优选资助课题)资助项目(104037)
