心脏型脂肪酸结合蛋白及缺血修饰清蛋白联合检测对早期急性心肌梗死的诊断价值

目的 探讨心脏型脂肪酸结合蛋白（H-FABP）和缺血修饰清蛋白（IMA）联合检测在急性心肌梗死（AMI）早期诊断中的价值.方法 结合临床检查,将2011年3月至2012年1月152例胸痛患者分为AMI胸痛患者组（A组,85例）、非AMI胸痛患者组（B组,67例）,并选取80例健康者作为对照组（C组）.采用免疫透射比浊法、游离钴比色法测定所有样本的IMA、H-FABP、肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）及肌红蛋白（MYO）水平,比较A、B、C组入院时5项指标阳性率;A、B组胸痛发作后3、6 h H-FABP、IMA指标阳性率;A组以上5项指标在胸痛发作后3、6、12、24 h对AMI诊断的阳性率以及A组患者胸痛发作3 h各项指标单独检测及H-FABP、IMA联合检测诊断AMI的灵敏度、特异度.结果 A组胸痛发作后6 h时IMA对AMI诊断的阳性率最高,为97.6%（83/85）,同时在胸痛发作后3 h和6 h时,H-FABP和IMA指标中A组阳性率明显高于B组阳性率,差异有统计学意义（P＜0.05）;A组在胸痛发作后3 h单独检测5项指标,发现IMA的灵敏度最高（94.1%）,H-FABP的特异度最高（96.0%）,H-FABP、IMA联合检测诊断AMI的敏感度、特异度分别为100.0%、99.5%.结论 H-FABP、IMA均为AMI检测的敏感性指标,H-FABP、IMA联合检测对AMI的早期诊断具有较高的灵敏度和特异度,可以减少误诊.

The diagnostic value of H-FABP and IMA in joint detection of AMI in early stage

Objective To discuss the value of heart-type fatty acid binding protein （H-FABP） and ischemia-modified albumin （IMA） in early diagnosis of acute myocardial infarction （AMI）. Methods Combined with Clinical examination, 152 patients with chest pain from March 2011 to January 2012 were divided into the patients with AMI and chest pain（group A, n=85 ） and the patients with non-AMI and chest pain （group B, n=67）, while 80 healthy subjects were selected as control （group C）. Im- munological transmission turbidimetry and free cobalt method were adopted to determine the level of IMA, H-FABP,cardiac tro- ponin I （cTn I ）,creatine kinase soenzyme （CK-MB） and myohemoglobin （MYO） in all subjects,so as to compare the positive rates of the above indicators among group A, group B and group C on admission, the positive rates of H-FABP and CK-MB of 3,6 h after chest pain between group A and group B,and the positive rates of above five indicators in group A to AMI diagnosis at 3,6,12 and 24 h after chest pain;to compare the sensitivity and specificity of all indexes alone detection 3 h after chest pain and combination detection of H-FABP and IMA in diagnosis of AM1 in group A. Results The positive rate of IMA to AMI diagnosis in group A reached to maximum on 6 h after onset of chest pain accounting for 97.6% （83/85）. Meanwhile, the positive rates of H-FABP and IMA in group A were obviously higher than those in group B on 3 h and 6 h after onset of chest pain with statistically significant difference （P〈0.05） ; the results of independent detection of 5 indexes 3 hours after onset of chest pain in group A showed that IMA was with the highest sensitivity of 94.1% ,H-FABP was with the highest specificity of 96.0% and the sensitivity and specificity of H-FABP and IMA in joint detection of AMI was 100.0% and 99.5% respectively. Conclusion Both H-FABP and IMA can be used as sensitive index for AMI detection, and the joint detection of IMA and H-FABP has higher sensitivity and speci- ficity in early diagnosis of AMI ,which can reduce misdiagnosis.