受试者特征曲线评价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

ROC curve estimates the value of heart-type fatty acid-binding protein for early detection of acute myocardial infarction

目的 探讨国内研制的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 应用酶联免疫吸附试验 (ELISA)对 5 3例AMI患者 ,分别于梗死后 2、4h进行血清心肌型脂肪酸结合蛋白H FABP、肌红蛋白 (MYO)、心肌型肌酸激酶同工酶 (CK MB)、肌钙蛋白I(cTnI)检测 ,并同时检测 12 6名健康体检者作对照 ,描绘各自的受试者特征 (ROC)曲线并进行ROC曲线分析。结果 AMI后H FABP、cTnI、CK MB、MYO 2h和 4h的ROC曲线下面积 (AUC)分别为 0 2 8、0 82 1、0 6 87、0 5 5 9和 0 95 1、0 880、0 797、0 75 9;2、4h各心肌标志物的ROC曲线下AUC大小依次为H FABP >cTnI>CK MB >MYO。其 2、4h的最佳截断点时灵敏度分别为 87 76 %、80 2 6 %、6 1 80 %、6 1 80 %和 88 12 %、83 0 8%、81 2 %、75 0 0 % ;特异度分别为 83 0 8%、84 12 %、6 2 5 0 %、4 7 12 %和 91 5 4 %、96 2 4 %、72 86 %、6 8 5 4 %。结论 H FABP较cTnI、CK MB、MYO对早期AMI具有更好的诊断价值 。

Objective To estimate the value of Heart type fatty acid binding protein for early diagnosis of AMI. Methods H FABP concentration of 126 healthy individuals and 53 AMI patients were measured by self development ELISA. MYO, cTnI, CK MB were estimated in the same time, then described ROC curves and analyzed. Results AUCs of H FABP, cTnI, CK MB, MYO were 0 928,0 821,0 687,0 559 at 2 hours and 0 951,0 880,0 797,0 759 at 4 hours after symptom onset,so the AUC of H FABP>cTnI>CK MB>MYO at both 2 hours and 4 hours. Sensitivities of above myocardial markers were 87 76, 80 26, 61 80, 61 80 and 88 12, 83 08, 81 2, 75 00, specificityies were 83 08, 84 12, 62 50, 47 12 and 91 54, 96 24, 72 86, 68 54 ,respectively, when the best cutoff values of them were definited. For this reason, H FABP has higher diagnostic efficiency than those traditional myocardial indicators for the early onset of AMI. Conclusion H FABP is superior in diagnostic value of AMI early stage than that of Infarction.