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目的探讨缺血修饰白蛋白(IMA)、心肌型脂肪酸结合蛋白(H-FABP)对心肌损伤患儿早期心肌缺血的诊断价值。方法选取2008年1月-2010年4月在本科住院的心肌损伤患儿62例为病例组。其中肺炎并先天性心脏病(CHD)26例,无CHD肺炎11例,心律失常13例,川崎病7例,CHD介入手术5例。健康对照组30例为本院儿童保健科体检健康儿童。2组儿童均抽取静脉血3 mL。应用清蛋白钴结合试验,采用比色法测定血清IMA水平;采用时间分辨免疫荧光法检测H-FABP水平;采用微粒子化学发光免疫法检测cTnI水平。应用SPSS 10.0软件对IMA、H-FABP和cTnI水平及阳性率进行统计学分析。结果病例组IMA阳性率(54.84%)显著高于H-FABP阳性率(24.19%)(P<0.001),且二者均高于cTnI阳性率(8.06%);肺炎并CHD和无CHD肺炎患儿IMA阳性率(65.38%、63.63%)显著高于H-FABP阳性率(38.46%、18.18%)(Pa<0.05);健康对照组IMA、H-FABP和cTnI的阳性率均为0,显著低于病例组,其差异有统计学意义(Pa<0.001)。结论血清IMA及H-FABP均为心肌损伤患儿早期心肌缺血的生化标志物,IMA较H-FABP能更早期为心肌缺血提供诊断依据。
Objective To investigate the diagnostic value of ischemic modified albumin (IMA) and cardiac fatty acid binding protein (H-FABP) in early myocardial ischemia in children with myocardial injury. Methods Totally 62 children with myocardial injury undergraduate admission from January 2008 to April 2010 were selected as the case group. There were 26 cases of pneumonia with congenital heart disease (CHD), 11 cases without CHD pneumonia, 13 cases of arrhythmia, 7 cases of Kawasaki disease and 5 cases of CHD intervention. Healthy control group of 30 cases of hospital health check-up children’s health section. 2 children were drawn venous blood 3 mL. Serum IMA levels were determined by colorimetric assay using albumin-cobalt binding assay, H-FABP level by time-resolved immunofluorescence assay, and cTnI level by chemiluminescence immunoassay. SPSS 10.0 software was used to analyze the levels of IMA, H-FABP and cTnI and the positive rate. Results The positive rate of IMA (54.84%) was significantly higher than that of H-FABP (24.19%) (P <0.001), and both of them were higher than that of cTnI (8.06%). The positive rates of IMA, H-FABP and cTnI in healthy children were significantly higher than that of H-FABP (65.38%, 63.63%, 38.46%, 18.18%, respectively) Lower than the case group, the difference was statistically significant (Pa <0.001). Conclusions Both serum IMA and H-FABP are biochemical markers of early myocardial ischemia in children with myocardial injury. IMA can provide a diagnostic basis for myocardial ischemia earlier than H-FABP.