心肌脂肪酸结合蛋白对早期急性心肌梗死的诊断

The role of heart-type fatty acid-binding protein in the diagnosis of acute myocardial infarction within early stage

目的研究血浆心肌脂肪酸结合蛋白(HFABP)在早期急性心肌梗死(AMI)诊断中的价值。方法选择93例发病6h内的胸痛患者,其中AMI组32例,非AMI组61例[含不稳定型心绞痛(UAP)24例,稳定型心绞痛(SAP)者22例,非心源性胸痛者15例];正常对照组选择69例正常人。采用双抗体夹心酶联免疫一步法检测正常人和患者发病0～3h或3～6h血浆的HFABP含量,并与心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CKMB)和肌红蛋白(MYO)的检测结果进行比较,分析4种生化标志物诊断发病3h内和6h内AMI的敏感性、特异性和准确性。结果在0～3h、0～6h时间段,HFABP诊断AMI的敏感性(64.29%、84.38%)显著高于cTnI(28.57%、53.13%)和CKMB(21.43%、56.25%),与MYO(71.43%、78.13%)比较差异无统计学意义;在诊断特异性上,4种生化标志物差异无统计学意义;在诊断准确性上,HFABP的ROC曲线下面积(0.979、0.958)显著高于cTnI(0.800、0.878)、CKMB(0.575、0.782)和MYO(0.796、0.882)。结论HFABP对于诊断早期AMI具有较高的敏感性和良好的特异性,其诊断准确性优于cTnI、CKMB、MYO。

Objective:To evaluate the value of heart-type fatty acid-binding protein(H-FABP) in the diagnosis of early acute myocardial infarction(AMI). Method:The plasma levels of H-FABP were measured by sandwich ELISA in 93 patients with suspected AMI at admission within 6 hours after onset of chest pain and 69 normal healthy subjects. The plasma concentrations of cardiac troponin-I(cTnI), creatine kinase-MB (CK-MB) and myoglobin (MYO) were assayed at the same time by using corpuscle chemiluminescence. The patients were classfied retrospectively as AMI group ( n =32), unstable angina(UAP) group ( n =24), stable angina(SAP) group ( n =22) and non-cardiac chest pain(NCCP) group ( n =15).The diagnostic validity was evaluated in terms of sensitivity, specificity and receiver operating characteristic (ROC) curve analysis. Result:The diagnostic sensitivity of H-FABP for AMI was 64.29 % within 3 hours and 84.38 % within 6 hours after onset of chest pain, significantly higher than that of cTnI (28.57%, 53.13%)and CK-MB(21.43%, 56.25%). There was no significant difference in specificity among the four markers. The area under the ROC curve of H-FABP(0.979, 0.958) within 3 hours and 6 hours was significantly larger than that of cTnI(0.8, 0.878), CK-MB(0.575, 0.782)and MYO (0.796, 0.882 ). Conclusion:H-FABP seems to be a useful biochemical cardiac marker for AMI in the early stage.