心肌型脂肪酸结合蛋白检测在急性心肌梗死早期诊断中的应用

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＜3 h、3～6 h和＞6 h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).＜3 h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％;3～6 h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％;＞6 h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.     

心脏型脂肪酸结合蛋白早期诊断急性心肌梗死的综合效果评价

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）的综合效果。方法选择2011年3月—2013年3月来我院就诊的疑似AMI患者210例,按急诊就诊时间分为0h～3h组和3h～6h组,测定患者血液中的H-FABP、肌钙蛋白（cTnI）、肌酸激酶同工酶（CK-MB）及肌红蛋白（MYO）水平,统计并比较4个心肌标志物的灵敏度、特异性、准确性、阳性预测值及阴性预测值。结果 0h～3h,H-FABP的敏感性、特异性、正确判断率、阳性预测值及阴性预测值分别均相应的高于cTnI、CKMB和MYO（P〈0.05或P〈0.01）。3h～6h,H-FABP的敏感性均高于cTnI、CK-MB和MYO（P〈0.05）,特异性高于MYO（P〈0.05）,阴性预测值均高于cTnI、CK-MB和MYO（P〈0.05）。结论 H-FABP在AMI的早期诊断中,有望取代传统的几种AMI早期诊断标志物。     

血浆心脏型脂肪酸结合蛋白检测在AMI早期诊断中的应用价值

目的 探讨血浆心脏型脂肪酸结合蛋白(H-FABP)检测在急性心肌梗死(AMI)早期诊断中的应用价值.方法 50例疑诊AMI的急性胸痛患者,按最终确诊结果分为AMI组28例、非AMI组22例,按胸痛时间分为＜2h和2～4h两组.50例患者胸痛发作4h内进行血浆H-FABP和肌钙蛋白I(cTnI)、肌红蛋白(MYO)检测,观察H-FABP对AMI早期诊断的敏感性和特异性.结果 胸痛发作≤4 h检测H-FABP、cTnI、MYO诊断AMI的敏感性分别为82.1％、46.4％、57.1％,前者与后两者相比,P均＜0.05;H-FABP、cTnI、MYO诊断AMI的特异性分别为86.4％、90.9％、59.1％,H-FABP诊断AMI的特异性与MYO相比,P＜0.05.胸痛发作＜2h和2～4h者检测H-FABP诊断AMI的敏感性分别为75.0％和91.7％.结论 血浆H-FABP检测在AMI的早期诊断中有重要应用价值,其敏感性高于cTnI、MYO,特异性高于MYO.     

3种心肌标志物在急性心肌梗死早期诊断中的价值

目的探讨肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)3种心肌标志物检测对急性心肌梗死(AMI)早期诊断的价值。方法用胶体金免疫层析法测定120例心肌梗死患者的3种血清心肌标志物的浓度,比较其对AMI诊断的性能价值。结果 120例心肌梗死患者在胸痛发作6h内检测cTnT、CK-MB和MYO的敏感率分别是81.4%、60.5%和97.7%,以MYO浓度升高最快,出现最早;发病6h～24h内检测cTnT、CK-MB和MYO的敏感率分别是99.0%、79.4%和79.0%,以cTnT浓度最稳定;在发病8h内检测cTnT、CK-MB和MYO的敏感性分别为91.0%、70.0%和99.0%,特异性分别为100%、91.0%和79.0%;漏诊率分别是9.0%、30.0%和1.0%;误诊率分别是0、9.0%和21.0%。结论 cTnT在AMI早期诊断中具有较高的敏感性、特异性和准确性,是早期诊断AMI的"金指标",MYO可作为AMI的过筛,三者结合可提高早期AMI的诊断率,并有助于病情的分析。     

心肌损伤标记物水平在不同类型冠心病中的观察研究

目的研究不同心肌损伤标记物诊断早期急性心肌梗死(AMI)的意义。方法选择胸痛患者60例,AMI组32例,UAP组18例,SAP组10例,ELISA法测定患者胸痛<3h,3～6h血心型脂肪酸结合蛋白(H-FABP)、单核细胞趋化蛋白1(MCP-1)、凝血酶原片段(F1+2)浓度变化,同时检测肌钙蛋白I(cTnI)和肌红蛋白(MYO)。分析胸痛<3h,≤6hH-FABP、MCP-1、F1+2诊断AMI的敏感性和特异性。结果与AMI组比较,UAP组和SAP组胸痛<3h,3～6h血浆H-FABP、MCP-1、F1+2、cTnI及MYO明显下降(P<0.05,P<0.01);与UAP组比较,SAP组胸痛<3h,3～6h血浆MCP-1、F1+2明显下降(P<0.05)。在胸痛<3h,≤6hH-FABP敏感性高于其他指标;胸痛<3h,≤6hH-FABP特异性均与cTnI相似,高于其他指标。胸痛≤6hF1+2及MCP-1敏感性、特异性较胸痛<3h明显升高,F1+2敏感性与MYO相似,但MCP-1敏感性与MYO相比仍较低。结论 H-FABP在时效方面更早于cTnI,总体诊断价值要优于cTnI,有望成为理想的早期诊断AMI的生化标记物。     

91例急诊胸痛检测心肌损伤标志物结果分析

目的探讨心肌损伤标志物即肌钙蛋白I(TnI)、肌红蛋白(MYO)、肌酸激酶同功酶(CK-MB)在急诊胸痛病人的诊断价值。方法91例急诊胸痛病人2h及4h后各定性检测一次心肌损伤标志物。结果TnI阳性42例,MYO阳性48例,CK-MB阳性51例。其中心肌梗死31例,不稳定心绞痛14例,稳定心绞痛7例。胸痛4h后三者诊断心肌梗死敏感性分别为100%、83.87%、54.83%,特异性分别为81.67%、71.67%、66.67%。结论心肌损伤标志物检测心肌梗死的早期诊断具有较高的敏感性,阳性应收住院进一步诊治。     

血清TpP、hs-CRP、CKMB、cTnI在急性心肌梗死中的诊断意义

目的探讨血栓前体蛋白(TpP)、高敏C反应蛋白(hs-CRP)、肌酸激酶同工酶(CKMB)及心肌肌钙蛋白I(cTnI)联合检测在急性心肌梗死(AMI)中的诊断价值。方法 测定26例急性心肌梗死患者胸痛发作6小时内及24小时TpP、hs-CRP、CKMB及cTnI。结果AMI胸痛发作6小时内TpP的敏感性最高,发病6小时后hs-CRP、CKMB及cTnI显著升高,cTnI阳性持续时间长,而hs-CRP在AMI时可出现明显升高。结论TpP对于AMI具有早期诊断价值,cTnI与hs-CRP、CKMB一起相互补充,具有重要的临床诊断及判断预后的意义。     

心肌型脂肪酸结合蛋白在急性心肌梗死早期诊断中的应用

目的　评定脂肪酸结合蛋白 (H FABP)在急性心肌梗死 (AMI)早期诊断中的应用。　方法　采用自行开发的H FABP酶联免疫吸附试验一步夹心法对 12 6名健康体检者和 5 3例AMI患者血清H FABP进行检测 ,同时测定肌红蛋白 (MYO)、肌酸激酶同工酶 (CK MB)、肌钙蛋白I(cTnI) ,并对AMI进行动态观察 ,对早期诊断的敏感性、特异性、时效性等进行分析。　结果　H FABP在AMI后 (1 84± 0 6 4 )h血浆浓度即开始升高 ,比CK MB、cTnI早 (P <0 0 1) ;时间浓度动态曲线与MYO相似 ,与CK MB、cTnI相比曲线前移。AMI后 2h的敏感性和特异性分别为 76 4 7%、80 4 1% ;4h的敏感性和特异性分别为 89 16 %、91 2 6 %。　结论　AMI后 2、4hH FABP检测对AMI早期诊断具有较高的敏感性和特异性 ,可望成为重要的早期和排除诊断的血清心肌标志物的手段之一。     

应用临床诊断性能曲线评价cTnT、CK-MB、MYO在老年急性心肌梗死诊断中的临床意义

目的 应用临床诊断性能(ROC)曲线评价心肌肌钙蛋白T(cTnT)、肌红蛋白(MYO)和肌酸激酶同工酶质量(CK-MB)在老年急性心肌梗死(AMI)诊断中的临床效果.方法 电化学发光免疫分析法测定病例组及对照组的血清cTnT、MYO和CK-MB,所得数据用ROC曲线统计软件进行分析.结果 入院即刻血清cTnT诊断AMI的最佳临界值为0.047 μg/L,诊断特异性98%、敏感性83.33% ;CK-MB的临界值为5.38 μg/L,诊断特异性97%、敏感性72.92%;MYO的临界值为63.05 μg/L,诊断特异性为95.65%、敏感性为62.5%.AMI患者胸痛发作6 h内MYO的诊断敏感性较高(88.9%),cTnT其次(61.1%),CK-MB最低(55.6%);6 h后MYO诊断敏感性仅为63.3%;cTnT上升为90%,CK-MB仍为66.7%.结论 cTnT不论是曲线下面积、诊断敏感性、特异性及准确性等方面都明显优于CK-MB和MYO,是诊断急性心肌损伤的"金标准".     

心肌型脂肪酸结合蛋白在急性心肌梗死早期诊断中的价值

急性心肌梗死(AMI)自胸痛发作到再灌注治疗的时间对预后有较大的影响,因而要求发病早期迅速确诊.既往一般多检测心肌肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnI或cTnT)和肌红蛋白(MYO),但CK-MB和cTnI(T)在心肌缺血时出现较晚,缺乏早期诊断AMI的敏感性.心肌细胞心肌型脂肪酸结合蛋白(Heart-type Fatty Acid-binding Protein,H-FABP)含量较骨骼肌高,与MYO相比具有更好的心肌特异性[1].     

急性心肌梗死心肌型脂肪酸结合蛋白的动态变化

目的　了解心肌型脂肪酸结合蛋白在急性心肌梗死 (AMI)后血清浓度变化特征 ,探讨其对AMI的潜在价值。方法　采用酶联免疫吸附实验一步夹心法对 12 6例健康体检者和 5 3例AMI患者进行血清心肌型脂肪酸结合蛋白(H FABP)检测 ,其中AMI患者分为再灌注组和非再灌注组 ,同时测定肌红蛋白、心肌型肌酸激酶同工酶、肌钙蛋白I,以各自的诊断参考值为基值作标准化比值时间曲线进行动态分析。结果　AMI后 2hH FABP和肌红蛋白血清浓度明显升高 ,峰值时间及恢复时间较肌酸激酶同工酶和肌钙蛋白I前移 ,脂肪酸结合蛋白、肌钙蛋白I峰值标准化比值显著高于肌红蛋白、肌酸激酶同工酶 ,再灌注组的H FABP较非再灌注组曲线前移和峰值增高更为显著。结论　H FABP将是一种可为临床提供多种有用信息 ,有重要临床价值的AMI心肌标志物     

The value of human heart-type fatty acid binding protein in diagnosis of patients with acute chest pain

BackgroundThe aim was to determine the efficacy of heart-type fatty acid-binding protein (H-FABP) compared with routinely myoglobin (MYO), creatine kinase-MB (CK-MB) and cardiac troponin-I (cTn-I) in the early diagnosis of acute myocardial infarction (AMI) in patients presenting with acute chest pain.Methods and resultsThe patients were classified as AMI (n = 22), unstable angina (UA, n = 20) and non-cardiac chest pain (NCCP, n = 15) within 3 h and 6 h of acute chest pain according to the American College/European Society of Cardiology; and normal healthy subjects (controls, n = 10). Blood H-FABP levels were measured by ELISA and compared with cTn-I, CK-MB and MYO in all subjects. The diagnostic sensitivity, specificity and receiver operating characteristic (ROC) curve were evaluated. Serum H-FABP, MYO, CK-MB and cTn-I were significantly higher in AMI more than the UA, NCCP (non-AMI) and control groups within 6 h. However, Serum H-FABP, MYO and CK-MB were significantly elevated within 0–3 h and extend more within 3–6 h in AMI versus non-AMI. The cutoff value of H-FABP in AMI was 21.85 ng/ml within 3 h, and has diagnostic sensitivity (81.8%) equal to that of CK-MB and cTn-I but superior to that of MYO (72.7%). However, H-FABP has higher specificity (88.2%) equal to that of MYO but superior to that of CK-MB and cTn-I. This trend extends to within 6 h as well. Moreover, ROC curve areas for H-FABP were significantly higher (p < 0.05) than other biomarkers <6 h after the onset of chest pain.ConclusionH-FABP can be used as a sensitive biomarker for myocardial injury in early stage.     

Heart-type fatty acid-binding protein (H-FABP) as an early diagnostic biomarker in patients with acute chest pain

Background

Heart-type fatty acid-binding protein (H-FABP) is an emerging biomarker, which was found to be sensitive for the early diagnosis of acute myocardial infarction (AMI). We prospectively investigated the usefulness of H-FABP determination for the evaluation of acute chest pain in patients arriving at the emergency department.

Methods

Fifty-four patients presenting with acute ischemic chest pain were evaluated. H-FABP was estimated at admission using latex-enhanced immunoturbidimetric assay. Serial cardiac troponin I (cTnI), creatinine kinase-MB (CK-MB) determination, ischemia workup with stress testing, and/or coronary angiogram (CAG) were performed according to standard protocols.

Results

The sensitivity and specificity of H-FABP was 89.7% and 68%, for cTnI it was 62.1% and 100%, and for CK-MB it was 44.8% and 92%, respectively for diagnosis of AMI. The sensitivity of H-FABP was found to be far superior to initial cTnI and CK-MB, for those seen within 6 h (100% vs. 46.1%, 33% respectively). On further evaluation of patients with positive H-FABP and negative cTnI, 71.4% of the patients had significant lesion on CAG, indicating ischemic cause of H-FABP elevation. Six patients with normal cTnI and CK-MB with high H-FABP had ST elevation on subsequent ECGs and were taken for primary angioplasty.

Conclusion

H-FABP is a highly sensitive biomarker for the early diagnosis of AMI. H-FABP as early marker and cTnI as late marker would be the ideal combination to cover the complete diagnostic window for AMI. Detection of myocardial injury by H-FABP may also be applied in patients with unstable angina. H-FABP can also be used as a marker for early detection of STEMI before the ECG changes become apparent.     

心肌型脂肪酸结合蛋白(H-FABP)与cTnI、CK-MB组合在诊断早期AMI中的比较

目的研究血清心肌型脂肪酸结合蛋白（H—FABP）在早期急性心肌梗死（AMI）诊断中的价值,比较不同心肌损伤标志物组合诊断早期AMI的价值。方法选择疑似急性冠脉综合征患者102例,采用酶联免疫吸附法（Elisa）测定AMI患者发病1h、2h、3h、4～6h、7～12h时血清H—FABP浓度变化,并与心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK—MB）的检测结果进行比较,分析3种心肌损伤标志物及不同心肌标志物组合H—FABP＋cTnI与H—FABP＋CK—MB在诊断不同发病时间段AMI的敏感性和特异性。结果①在AMI发病3h内,H—FABP的诊断敏感性（66．7％）优于cTnI（0％）和CK—MB（0％）,差异有统计学意义（P〈0．05）。在AMI发病4～6h内,H—FABP的敏感性（94．4％）仍高于cTnI（61．1％）和CK—MB（50％）,差异有统计学意义（P〈0．05）。②H—FABP＋cTnI组合对AMI的诊断敏感度最高（95．8％）,特异度亦最高（100％）。H-FABP＋cTnI组合次之,分别为93．75％和97．2％。这两种组合对AMI的诊断敏感度与单个H—FABP、cTnI和CK—MB比较,差异有统计学意义（P〈0．05）,诊断特异度亦明显升高。结论在AMI发病6h内,H—FABP是最为敏感的心脏标志物,尤以发病3h内最敏感。H—FABP与不同心肌损伤标志物cTnI和CK—MB的组合均具有较高的敏感性和特异性,可提高早期诊断AMI的准确率。     

心肌型脂肪酸结合蛋白(H-FABP)在诊断早期AMI中的临床应用

目的探讨血清心肌型脂肪酸结合蛋白（H—FABP）在早期急性心肌梗死（AMI）诊断中的价值。方法选择疑似急性冠脉综合征患者102例,采用酶联免疫吸附法（Elisa）测定AMI发病3h内,4～6h、7～12h时血清中H—FABP浓度,并与心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK—MB）的检测结果进行比较,分析三种心肌损伤标志物在诊断不同发病时间段AMI的敏感性和特异性。结果在AMI发病3h内,H—FABP的诊断敏感性（66．7％）优于cTnI和CK—MB（P〈0．05）;在发病4～6h内,H—FABP的敏感性（94．4％）高于cTnI（61．1％）和CK—MB（50．0％）,差异有统计学意义（P〈0．05）。结论在AMI发病6h内,H—FABP是最敏感的心脏标志物,尤以发病3h内敏感。     

The use of human heart-type fatty acid-binding protein as an early diagnostic biochemical marker of myocardial necrosis in patients with acute coronary syndrome, and its comparison with troponin-T and creatine kinase–myocardial band

Heart-type fatty acid-binding protein (H-FABP), a new biochemical marker of sarcolemmal injury due to acute myocardial ischemia, can be used as a tool in early diagnosis and management of patients at high risk. The aim of this study was to determine the early diagnostic value of H-FABP in acute coronary syndrome (within 6–24 h of chest pain) and to compare it with troponin-T (TnT) and creatine kinase–myocardial band (CK-MB) for accuracy. The study consisted of 40 consecutive patients with chest pain admitted to the coronary care unit with the diagnosis of suspected acute coronary syndrome. The patient population consisted of two groups according to the time of admission; the first group (26 patients) included patients admitted within 6 h of chest pain, and the second group (14 patients) included patients admitted within 6–24 h of chest pain. The blood samples for H-FABP, TnT, and CK-MB were obtained at admittance, at the 6th, and at the 24th hours for the first group, and at admittance and at the 24th hours for the second. Statistical analysis was performed among the 26 patients for the first 6 h values, and among all 40 patients for the values obtained within 6–24 h and at the 24th hour. The patients were then divided into groups according to the changes in the electrocardiogram (ECG) and cardiac enzymes as unstable angina pectoris, non-ST elevation myocardial infarction (MI), and ST-elevation MI. Coronary angiography was performed in 38 (95%) patients. Sensitivity of TnT, CK-MB, and H-FABP in the first group (within 6 h of chest pain) were 38%, 76%, and 95% respectively. The sensitivity of H-FABP was significantly higher than TnT (P = 0.014). Sensitivity of TnT, CK-MB, and H-FABP tests in the second time period (within 6–24 h of chest pain) were 100%, 90%, and 91% respectively. In this time period, the sensitivity of TnT was higher than H-FABP, but it was statistically insignificant. At the 24th hour, sensitivity of TnT was 100%, CK-MB 90%, and H-FABP 27.3%, and TnT and CK-MB were more sensitive than H-FABP for the whole group (P = 0.002). In the first group (within 6 h of chest pain) H-FABP positivity was slightly but insignificantly higher in patients with two- and three-vessel disease compared with those with one-vessel disease (60.7% and 33.3%, P = 0.19) and in the same group, patients who underwent primary coronary intervention had a significantly higher H-FABP positivity than others (80%, 32%, P = 0.02). Within 6–24 h of chest pain, H-FABP positivity was 80% in patients with one-vessel disease and 71.4% in patients with two- and three-vessel disease (P = 0.69). Within 6–24 h, positivity of H-FABP reached a peak value of 100% in patients who underwent primary coronary intervention, while H-FABP was positive in 60% of the others (P < 0.001). We conclude that within the 6 h of acute coronary syndrome, H-FABP seems to be a more sensitive biochemical marker than TnT in the early detection of ischemic myocardial necrosis. But after the first 6 h of the onset of chest pain the sensitivity of H-FABP decreases, and this marker should not be used alone in patients admitted 24 h after the onset of chest pain.     

心型脂肪酸结合蛋白在急性冠脉综合征患者中的变化及其临床意义

目的探讨心型脂肪酸结合蛋白(H-FABP)在急性冠脉综合征(ACS)患者中的变化及其临床意义。方法冠心病患者110例并行冠脉造影证实,其中急性心肌梗死(AMI)35例、不稳定型心绞痛(UAP)45例,稳定型心绞痛30例。采用双抗体夹心ELISA法定量测量待测血清HFABP、Myo、cTn和CK-MB浓度,根据美国心脏病协会所规定的冠状动脉血管图像记分分段评价标准,对病变狭窄程度进行分度,累及血管支数计算;用卡方检验分析血HFABP、Myo和cTnI以及CK-MB与患者冠状动脉狭窄程度、病变支数的相关性。结果 AMI患者H-FABP、CK-MB、MYO、cTnI较健康体检者、稳定型心绞痛和不稳定型心绞痛患者显著增高(P<0.01),UAP患者H-FABP也较SAP患者升高(P<0.01),无论是胸痛发生3小时前还是3小时之后,H-FABP的阳性率均比Myo和CK-MB以及cTnI敏感性更高(P<0.01)。在ACS患者H-FABP无论在发病3小时之前还是之后均较Myo和cTnI以及CK-MB更早出现(P<0.05)。ACS患者H-FABP的水平与冠脉狭窄程度及病变支数明显相关,即双支病变和多支病变高于单支病变,重度狭窄高于中度和轻度狭窄病变(P<0.05)。ACS患者的心脏射血分数(EF值)小于40%的H-FABP水平要高于EF大于40%的H-FABP水平(P<0.05)。结论 H-FABP对ACS的诊断较Myo、CK-MB和cTnI更敏感。H-FABP、Myo、cTnI以及CK-MB的联合检测与ACS的患者冠状动脉病变严重程度呈正相关,H-FABP与冠脉病变程度相关程度更高。血清H-FABP、Myo、cTnI以及CK-MB升高是冠状动脉病变加重的结果。     

心肌损伤标志物对心肌梗死与心绞痛的鉴别诊断效率评价

目的评价几种心肌损伤标志物用于急性心肌梗死(AMI)与心绞痛的鉴别诊断效率。方法选择解放军第306医院2002年11月至2004年11月收治的住院患者188例,其中AMI组92例,心绞痛组96例。肌钙蛋白I(TnI)和肌红蛋白(Myo)测定用化学发光法,肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH)用酶动力连续监测法,超敏C-反应蛋白(hs-CRP)用增强胶乳免疫浊度法。采用受试者操作特性曲线(ROC)分析曲线下面积和敏感度、特异性。结果AMI发生≤6h的ROC曲线下的面积依次为Myo0·92、TnI0·92、CK0·81、CK-MB0·81、AST0·78、hs-CRP0·73、LDH0·70、HBDH0·65;AMI发生>6h依次为TnI0·93、AST0·86、CK-MB0·84、CK0·80、Myo0·76、HBDH0·72、LDH0·70、hs-CRP0·56;AMI发生≤6h的敏感性和特异性TnI0·87和0·90、Myo0·96和0·78、CK0·83和0·67、CK-MB0·65和0·82、AST0·69和0·77、LDH0·64和0·73、HBDH0·71和0·65、hs-CRP0·64和0·82。阳性似然比最高为TnI8·8,阴性似然比最低为Myo0·05。结论AMI与心绞痛鉴别诊断效率依次为TnI、Myo、CK-MB、CK;Myo在AMI发作6h以后的诊断效率降低,AST、LDH、HBDH仍有意义。