心脏型脂肪酸结合蛋白在急性心肌梗死早期诊断中的应用价值

目的探讨心脏型脂肪酸结合蛋白（H-FABP）在急性心肌梗死（AMI）患者中的临床应用价值。方法对于48例疑为急性冠脉综合征（ACS）的患者人院即刻查心电图及传统心肌损伤标志物，包括肌红蛋白（MYO）、心脏型肌钙蛋白T（CT—nT）、肌酸激酶同工酶（（KMB），同时采血分离斑清行H-FABP定性测试。结果H-FABP检测AMI的敏感性显著高于CKMB及肿，与MY（）相似，其特异性与CFnT相似，略高于CKMB及MYO；H-FABP联合cTnT及CKMB诊断AMI的敏感性与MYO＋CKMB＋d、nT组合相州，但特异性略高于后者。4种心肌损伤标志物联合敏感性进一步提高，但特异性低于前述3项联合。对于症状出现3h内就诊的患者，H—FABP检测AMI的敏感性与MYO无显著差异，但显著高于CKMB及cTnT；H—FABP检测AMI特异性与MYO、cTnT及CKMB无显著差异；在AMI早期诊断敏感性及特异性方面，三种组合方案均无显著差异。结论H-FABP定性检测在AMI的早期诊断过程中具有明显高于CKMB及cTnT的敏感性，在急诊一线工作中值得推广。

Application value of heart - type fattyacid - binding protein in early diagnosis of acute myocardial infarction

Objective To evaluate the clinical application value of heart- type fattyacid- binding protein （H-FABP） in the early diagnosis of acute myocardial infarction （AMI）. Methods Forty- eight suspected acute coronary syndrome （ACS） patients received electrocardiogram （ECG） and traditional cardial injury markers including myohemoglobin （MYO）, myocardial tro- ponin T （CTnT） and creatine kinase isoenzyme （CKMB） were examined immediately after admis- sion into hospital. Meanwhile, their blood was drawn and the serum was separated to conduct H- FABP qualitative test. Results The sensitivity of H - FABP was significantly higher than that of CKMB and cTnT in detection of AMI, similar to that of MYO. The specificity of H - FABP was similar to that of cTnT, and slightly higher than that of CKMB and MYO, but showed no signifi- cant difference. The sensitivity of H- FABP combined with cTnT and CKMB was equal to that of MYO ＋ CKMB ＋ cTnT in diagnosis of AMI, but the specificity was slightly higher than the latter. Besides, the combination of 4 cardial injury biomarkers improved the sensitivity further, but the specificity was lower than the aforementioned combination of 3 cardial injury biomarkers. Within 3 h after symptoln appearance, the sensitivity of H - FABP was significantly higher than that of CKMB and cTnT, similar to that of MYO： No significant difference was found about the specificity between H - FABP and cTnT, CKMB and MYO. There were no significant differences among three combinations in the aspect of early diagnosis of AMI sensitivity and specificity. Conclusion Qualitative detection of H - FABP has higher sensitivity than CKMB and eTnT in the early process of diagnosing AMI, worthy of being promoted in the first - line emergency.