论文部分内容阅读
目的探讨血清心型脂肪酸结合蛋白(H-FABP)在急性心肌梗死(AMI)早期诊断中的临床应用价值。方法随机选择110例临床疑似AMI胸痛患者,采用时间分辨免疫荧光测定法(TRIFA)检测患者入院即刻血清中H-FABP含量,并与心肌肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hsCRP)和肌红蛋白(MYO)进行比较;对11例患者入院即刻和入院6 h后进行动态分析;以60例体检健康者作对照,绘制各心肌损伤标志物受试者工作特征(ROC)曲线并进行曲线下面积(AUC)比较,分析6种心肌损伤标志物诊断早期AMI的敏感度和特异度。结果 AMI患者入院即刻各心肌损伤标志物的AUC由大到小依次为H-FABP、hsCRP、cTnI、CK-MB、CK和MYO,最佳临界值诊断灵敏度分别为85.0%、78.7%、81.3%、73.8%、72.5%和61.3%,特异度分别为93.3%、95.0%、93.3%、100.0%、100.0%、98.3%。H-FABP的AUC与hsCRP、cTnI比较差异无统计学意义(P>0.05),与CK-MB、CK、MYO比较差异有统计学意义(P<0.05)。H-FABP诊断早期AMI的阳性率达85.0%。结论 H-FABP对于AMI早期诊断具有相对较早的检测窗口期和相对较好的特异度,在时效性、灵敏度和特异度等方面具有综合优势,可作为AMI早期诊断或排除诊断的血清标志物。多项心肌损伤指标联合检测可提高AMI实验室诊断的灵敏度、特异度及准确性。
Objective To investigate the clinical value of serum cardiac fatty acid binding protein (H-FABP) in the early diagnosis of acute myocardial infarction (AMI). Methods One hundred and ten cases of suspected AMI patients with chest pain were randomly selected. The serum levels of H-FABP in hospitalized patients were detected by time-resolved immunofluorescence assay (TRIFA), and were compared with those of cardiac troponin I, CK, CK-MB, hsCRP, and myoglobin (MYO) were compared; 11 patients were admitted to hospital immediately after admission and 6 h after the dynamic analysis; 60 cases of physical examination and health (ROC) curve and the area under the curve (AUC) of each myocardial injury marker were compared to analyze the sensitivity and specificity of six kinds of myocardial injury markers in the diagnosis of early AMI. Results The AUC of each myocardial injury markers immediately after admission was H-FABP, hsCRP, cTnI, CK-MB, CK and MYO, respectively. The sensitivity of the best cutoff value was 85.0%, 78.7% and 81.3% , 73.8%, 72.5% and 61.3%, respectively. The specificity was 93.3%, 95.0%, 93.3%, 100.0%, 100.0% and 98.3% respectively. There was no significant difference in AUC, hsCRP and cTnI between H-FABP and CK-MB, CK, MYO (P <0.05). H-FABP diagnosis of early positive rate of AMI 85.0%. Conclusion H-FABP has a relatively early detection window and a relatively good specificity for early diagnosis of AMI, and has comprehensive advantages in timeliness, sensitivity and specificity, and can be used as a serum marker for early diagnosis or diagnosis of AMI . A number of myocardial injury indicators combined detection can improve the sensitivity, specificity and accuracy of AMI laboratory diagnosis.