心型脂肪酸结合蛋白在急性心肌梗死患者早期诊断中的应用价值

目的: 探讨血清心型脂肪酸结合蛋白（heart-type fatty acid-binding protein,H-FABP）在急性心肌梗死（acute myocardial infarction,AMI）早期诊断中的应用价值。方法: 应用乳胶凝集法检测105例因胸痛疑似AMI就诊患者的血清H-FABP,同时测定患者血清中肌酸激酶同工酶MB（creatine kinase isoenzyme MB,CK-MB）、肌红蛋白（myoglobin, MYO）和心肌钙蛋白I（cardiac troponinc I,cTnI）。根据最终的临床诊断将患者分为AMI组和非AMI组（对照组）,并对2组检测结果的阳性率、诊断效率等进行分析比较。结果: 105例疑似AMI患者中,最终诊断为AMI患者45例,其余60例排除AMI诊断作为对照组。AMI组的H-FABP、cTnI、MYO、CK-MB平均水平及阳性率分别为（49.32±10.29） ng/mL、84.4%,（1.62±0.76） ng/mL、44.4%,（156.14±54.23） ng/mL、82.2%,（13.01±6.08） ng/mL、42.2%,均高于对照组（P<0.05）;AMI组中H-FABP阳性率与MYO阳性率间无统计学差异（P>0.05）,但明显高于cTnI及CK-MB的阳性率（P<0.05）。H-FABP与CK-MB诊断AMI的特异度相似（P>0.05）,但低于cTnI（P<0.05）,高于MYO（P<0.05）。H-FABP与cTnI的阳性预测值相似（P>0.05）,均高于MYO、CK-MB（P<0.05）。在阴性预测值方面,H-FABP与MYO相似（P>0.05）,明显高于cTnI和CK-MB（P<0.05）。4项指标检测结果进行组合分析,H-FABP+ cTnI、H-FABP+ CK-MB、H-FABP+ MYO、H-FABP+ cTnI+MYO、H-FABP+ cTnI+CK-MB、H-FABP+ cTnI+MYO+CK-MB诊断AMI的灵敏度均为100.0%,特异度分别为82.0%、72.0%、61.2%、59.3%、68.1%和56.5%。结论: H-FABP在AMI早期诊断中具有较好的灵敏度和特异度,与cTnI联合检测,可显著提高AMI早期诊断效能。

Clinical value of heart-type fatty acid-binding protein in early diagnosis of acute myocardial infarction

Objective: To investigate the clinical value of heart-type fatty acid-binding protein (H-FABP) in early diagnosis of acute myocardial infarction (AMI). Methods: Serum concentration of H-FABP was measured with latex agglutination assay in 105 cases of suspected AMI because of chest pain. Cardiac troponin I (cTnI), myoglobin (MYO) and creatine kinase isoenzyme MB(CK-MB) were detected simultaneously. According to final clinical diagnosis, patients were divided into AMI group (n=45) and non-AMI group (control group, n=60). Related data between the two groups was compared. Results: The concentration and positive rate of H-FABP, cTnI, MYO and CK-MB were (49.32±10.29) ng/mL and 84.4%, (1.62±0.76) ng/mL and 44.4%, (156.14±54.23) ng/mL and 82.2%, (13.01±6.08) ng/mL and 42.2%, respectively, and all were higher in AMI group than those in control group (P<0.05). The difference in positive rate between H-FABP and MYO in AMI group was not significant (P>0.05), however, the positive rate of H-FABP and MYO was significantly higher than cTnI and CK-MB (P<0.05). The specificity of H-FABP was similar to that of CK-MB (P>0.05), and both of them were lower than cTnI (P<0.05) and higher than MYO (P<0.05). The positive predictive value of H-FABP was equal to cTnI (P>0.05), and both of them were significantly higher than MYO and CK-MB (P<0.05). The negative predictive value between H-FABP and MYO was not significantly different (P>0.05), and both of them were significantly higher than cTnI and CK-MB (P<0.05). Combinedly, the sensitivity of H-FABP+ cTnI, H-FABP+ CK-MB, H-FABP+ MYO, H-FABP+ cTnI+MYO, H-FABP+ cTnI+CK-MB and H-FABP+ cTnI+MYO+CK-MB were all of 100.0%, and the specificity were 82.0%, 72.0%, 61.2%, 59.3%, 68.1% and 56.5%, respectively. Conclusions: H-FABP has a moderately high sensitivity and specificity for early diagnosis of AMI. Furthermore, H-FABP in combination with cTnI can significantly improve the efficacy in early diagnosis of AMI.