摘要
目的研究比较急性心肌梗死、不稳定型心绞痛、稳定性心绞痛患者血中肌钙蛋白I(cTnI)、磷酸肌酸激酶同工酶(CK-MB)、心肌型脂肪酸结合蛋白(H-FABP)、超敏C反应蛋白(Hs-CRP)、D-二聚体(DD)和纤维蛋白原(Fg)差异和变化,探讨上述指标在急性心肌梗死诊治中的应用价值。方法 150例冠心病患者分为急性心肌梗死组(AMI)、稳定性心绞痛组(SAP)、不稳定型心绞痛组(UAP),分别采用免疫透射比浊法、凝血酶比浊法和免疫层析法测定CK-MB、Hs-CRP、DD、Fg、cTnI和H-FABP,同时选取35例健康人作为正常对照组。结果①入院12 h时,AMI组各项指标中以cTnI(87.5%)、CK-MB(93.8%)和H-FABP(92.8%)阳性率最高,且与UAP组、SAP组和对照组差异有统计学意义(P<0.01)。②CK-MB、cTnI和H-FABP联合检测诊断AMI的灵敏度和特异度分别为98.0%和100%,优于三者单独检测。③AMI组Hs-CRP、DD和Fg水平均显著高于UAP组、SAP组和对照组(P<0.05),而SAP组和对照组SA间差异无统计学意义(P>0.05)。④AMI组患者溶栓治疗后48 h内Hs-CRP含量持续增加,与治疗前比较差异有统计学意义(P<0.05);DD水平在溶栓后12h内明显下降(P<0.05),Fg水平明显升高(P<0.05),至治疗后48h,两者有不同程度恢复。结论联合检测cTnI、CK-MB和H-FABP可减少误诊,提高急性心肌梗死诊断的正确性,而Hs-CRP、DD和Fg对于急性心肌梗死病情判断、疗效观察和指导用药有重要意义。
Objective To investigate the changes of cTnI,CK-MB,HFABP,Hs-CRP,DD and Fg in patients with acute myocardial infarction（AMI）,unstable angina pectoris（UAP） and stable angina pectoris（SAP）,exploring their clinical value in diagnosis and treatment of AMI. Methods 150 cases with ACS were divided into AIM group,UAP group and SAP group,with 35 healthy cases as control.CK-MB,cTnI,H-FABP,Hs-CRP,DD and Fg were determined by immune turbidimetric method,Clauss method and immune chromatography,respectively. Results ①The positive rates of cTnI（87.5%）,CK-MB（93.8%）,H-FABP（92.8%） in AMI group were significantly higher than that in UAP group,SAP group and control group at 12 hours after admission（P0.01）.② When CK-MB,cTnI and H-FABP indexes were independently detected at 12 hours,the sensitivity and specificity of combined CK-MB,cTnI and H-FABP were 98.0% and 100.0% respectively,better than CK-MB,cTnI and H-FABP alone.③ The hs-CRP,DD and Fg levels of AMI group were significantly higher than those of UAP group,SAP group and control group（P0.05）,and there was no significant difference between SAP group and control group（P0.05）.④ Levels of Hs-CRP increased continuously within 12 hours after treatment,higher than before treatment（P0.05）;Within 12 hours after treatment,opposite to the decrease of DD levels,the levels of Fg increased significantly（P0.05）.Both levels had some degree of recovery after treatment in 48 hours. Conclusion Combined CK-MB,cTnI and H-FABP CK-MB indexes can be used to diagnose AMI,while Hs-CRP,DD and Fg are helpful to the treatment of AMI.
出处
《实用预防医学》
CAS
2011年第1期135-137,共3页
Practical Preventive Medicine
