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目的:探讨心肌型脂肪酸结合蛋白(H-FABP)在急性心肌梗死(AMI)早期诊断中的应用价值。方法:选择110例因急性胸痛住院的患者,按胸痛发作时间到就诊时间先后分为<3h、3～6h和>6h三组,检测各组H-FABP、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)水平变化,比较3种心肌标志物诊断早期AMI的敏感性、特异性、阳性预测值、阴性预测值,同时比较胸痛发作≤6h时不同心肌标志物联合诊断AMI的敏感性、特异性、阳性预测值、阴性预测值。结果:入选病例最终确诊为AMI 62例,非AMI 48例(其中不稳定型心绞痛20例,稳定型心绞痛18例,非心源性胸痛10例)。<3h组H-FABP、CK-MB、cTnI水平诊断AMI的敏感性分别为87.5%、9.1%、45.8%;特异性分别为83.3%、91.6%、91.6%;3～6h组H-FABP、CK-MB、cTnI水平诊断AMI的敏感性分别为98.1%、54.5%、63.6%;特异性分别为94.4%、88.9%、93.7%;>6h组H-FABP、CK-MB、cTnI水平诊断AMI的敏感性分别为81.3%、93.7%、75.0%;特异性分别为83.3%、94.4%、100%;3种检测指标的特异性、阴性预测值、阳性预测值差异无统计学意义(P>0.05);胸痛发作≤6h时H-FABP与cTnI联合检测诊断AMI的敏感性为93.5%、特异性为85.4%,cTnI与CK-MB联合检测诊断AMI的敏感性为74.1%、特异性为87.5%。结论:H-FABP水平检测对于早期诊断AMI有较高的敏感性,优于传统指标CK-MB、cTnI,但特异性、阳性预测值、阴性预测值与CK-MB、cTnI相当。胸痛发作≤6h时H-FABP与cTnI联合检测可进一步提高AMI早期诊断的敏感度,优于传统的cTnI与CK-MB联合检测。
Objective: To investigate the value of myocardial fatty acid binding protein (H-FABP) in the early diagnosis of acute myocardial infarction (AMI). Methods: One hundred and ten hospitalized patients with acute chest pain were selected and divided into three groups according to time of onset of chest pain and time of visit: <3h, 3h and 6h. H-FABP and CK- MB) and cTnI levels were compared. The sensitivity, specificity, positive predictive value and negative predictive value of three myocardial markers in diagnosing early AMI were compared. At the same time, the combined diagnosis of different myocardial markers AMI sensitivity, specificity, positive predictive value, negative predictive value. Results: The final diagnosis of AMI cases were 62 cases of non-AMI 48 cases (including unstable angina pectoris 20 cases, 18 cases of stable angina pectoris, non-cardiac chest pain in 10 cases). The sensitivity of H-FABP, CK-MB and cTnI in diagnosing AMI at 3h were 87.5%, 9.1% and 45.8%, respectively; the specificity was 83.3%, 91.6% and 91.6% The sensitivity of CK-MB and cTnI in the diagnosis of AMI were 98.1%, 54.5% and 63.6% respectively, and the specificity was 94.4%, 88.9% and 93.7% respectively. The levels of H-FABP, CK- The sensitivity was 81.3%, 93.7% and 75.0% respectively; the specificity was 83.3%, 94.4% and 100% respectively. There were no significant differences in the specificity, negative predictive value and positive predictive value of the three test indexes (P> 0.05). The sensitivity and specificity of combined detection of H-FABP and cTnI for AMI were 93.5% and 85.4%, respectively. The sensitivity and specificity of cTnI and CK-MB in diagnosing AMI were 74.1% and 87.5 %. Conclusion: The detection of H-FABP level is more sensitive to early diagnosis of AMI than CK-MB and cTnI, but the specificity, positive predictive value and negative predictive value are comparable to those of CK-MB and cTnI. Combined detection of H-FABP and cTnI can further improve the sensitivity of early diagnosis of AMI when chest attack is less than 6h, which is better than the traditional cTnI and CK-MB combined detection.