心肌型脂肪酸结合蛋白（H—FABP）与cTnI、CK—MB组合在诊断早期AMI中的比较

The use of human heart-type fatty acid-binding protein as an early diagnostic biochemical marker of acute myocardial infarction, and its combination1 with troponin-I and creatine kinase-myocardial band

目的研究血清心肌型脂肪酸结合蛋白（H—FABP）在早期急性心肌梗死（AMI）诊断中的价值，比较不同心肌损伤标志物组合诊断早期AMI的价值。方法选择疑似急性冠脉综合征患者102例，采用酶联免疫吸附法（Elisa）测定AMI患者发病1h、2h、3h、4～6h、7～12h时血清H—FABP浓度变化，并与心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK—MB）的检测结果进行比较，分析3种心肌损伤标志物及不同心肌标志物组合H—FABP＋cTnI与H—FABP＋CK—MB在诊断不同发病时间段AMI的敏感性和特异性。结果①在AMI发病3h内，H—FABP的诊断敏感性（66．7％）优于cTnI（0％）和CK—MB（0％），差异有统计学意义（P〈0．05）。在AMI发病4～6h内，H—FABP的敏感性（94．4％）仍高于cTnI（61．1％）和CK—MB（50％），差异有统计学意义（P〈0．05）。②H—FABP＋cTnI组合对AMI的诊断敏感度最高（95．8％），特异度亦最高（100％）。H-FABP＋cTnI组合次之，分别为93．75％和97．2％。这两种组合对AMI的诊断敏感度与单个H—FABP、cTnI和CK—MB比较，差异有统计学意义（P〈0．05），诊断特异度亦明显升高。结论在AMI发病6h内，H—FABP是最为敏感的心脏标志物，尤以发病3h内最敏感。H—FABP与不同心肌损伤标志物cTnI和CK—MB的组合均具有较高的敏感性和特异性，可提高早期诊断AMI的准确率。

Objective To determine the early diagnostic value of H-FABP in acute myocardial infarction （AMI） and to compare the diagnostic accuracy of different combination regimens of myocardial infarction markers （H-FABP＋cTnI and H-FABP＋CK-MB）. Methods The study consisted of 102 consecutive patients with the diagnosis of suspected acute coronary syndrome. The patients were then divided into groups of acute myocardial infarction（AMI）,unstable angina pectoris and non-acute coronary syndrome. The blood samples for H-FABP,cTnI, and CK-MB were obtained at admittance,at the 1th,2th,3th and within 4-6 h,7-12 h hour. The sensitivity and specificity in diagnosis of early AMI were analyzed between H- FABP and cTnI and CK- MB. Results The overall sensitivities of H-FABP,cTnI and CK-MB,were 66.7% ,0% and 0% respectively for AMI patients presented within 3 h of onset of symptom. The sensitivity of H-FABP was significantly higher than cTnI and CK-MB （P〈0.05）. Sensitivity of H-FABP, cTnI and CK-MB within the 4-6 h of were 94.4%,61.1% and 50% respectively（P〈0.05 ）. The sensitivity of the combination regimens of H-FABP＋cTnI and H-FABP＋CK-MB were 95.8% and 93.75% respectively, more than single H-FABP, cTnI and CK-MB in the diagnosis of AMI. They were statistically significant（P〈0.05 ）. While the relative specificities were 100% and 97.2%. Conclusion H-FABP is more sensitive in diagnosing AMI in the early phase within the 6h as an early diagnostic cardiac marker of myocardial necrosis than cTnI and CK-MB. The combination of H-FABP＋cTnI seems to be more accuracy than H-FABP＋ CK-MB in diagnosing AMI.