心型脂肪酸结合蛋白和缺血修饰白蛋白在肌钙蛋白T未增高的急性冠状动脉综合征患者中联合检测的价值

The value of combination determination of heart-type fatty acid binding protein and ischemia-modified albumin in patients with acute coronary syndrome and without increased troponin T level

目的探讨心肌损伤标志物——心型脂肪酸结合蛋白（H-FABP）和心肌缺血标志物——缺血修饰白蛋白（IMA）联合检测能否提高冠状动脉综合征（ACS）的诊断效率。方法测定108例胸痛患者[包括82例ACS患者及26例非缺血性胸痛（NICP）患者]血清IMA及H-FABP水平。血清IMA检测采用白蛋白钴结合（ACB）法,H-FABP采用免疫层析法检测。结果ACS组ACB水平[64（61-67）U/mL]明显低于NICP组[75（71-78）U/mL]（P〈0.05）。通过受试者工作特征（ROC）曲线分析,ACB水平的合适诊断界值为70.5 U/mL。ACB水平〈71.0 U/mL时敏感性和特异性分别为89.0%和80.8%,ROC曲线下面积（AUC）为0.876[95%可信区间（CI）：0.783-0.970],阳性预测值和阴性预测值分别为93.6%和70.0%。H-FABP的诊断敏感性和特异性分别为82.9%[95%C：I 74.8%-91.0%]和80.8%[95%CI：65.7%-95.9%],诊断准确性为82.4%[95%CI：75.2%-89.6%]。IMA与H-FABP联合检测的敏感性及特异性分别为96.3%[95%C：I 96.2%-100%]和80.8%[95%C：I 65.7%-95.9%],诊断的准确性为92.6%[95%C：I 87.7%-97.5%]。与IMA及H-FABP单独检测相比,二者联合检测的敏感性及诊断的准确性明显提高（P〈0.05）,阳性预测值与阴性预测值分别为94.0%和87.5%。结论胸痛发生后联合检测IMA和H-FABP可能提高肌钙蛋白T未增高的ACS患者的诊断效率。

Objective To investigate the diagnostic efficiency of the combination determination of heart-type fatty acid binding protein（H-FABP） as a marker for ongoing myocardial damage and ischemia-modified albumin（IMA） as a marker for myocardial ischemia in patients with acute coronary syndrome（ACS）.Methods The levels of IMA and H-FABP were measured in 108 patients with chest pain,including 82 patients with ACS and 26 patients with non-ischemia chest pain（NICP）.Serum IMA was measured by albumin cobalt binding（ACB） test.H-FABP was measured by immunochromatography assay.Results Serum samples from ACS group had decreased level of ACB [64（61-67）U/mL] compared with NICP group samples [75（71-78）U/mL]（P〈0.05）.The optimum diagnostic cut-off value for ACB level was 70.5 U/mL by reciver operating characteristic（ROC） curve analysis.When ACB level 〈71.0 U/mL,the sensitivity was 89.0%,and the specificity was 80.8%.The area under ROC curve（AUC） was 0.876 [95% confidence interval（CI）： 0.783-0.970].The positive predictive value and negative predictive value were 93.6% and 70.0% respectively.The sensitivity and specificity of H-FABP were 82.9% [95%CI： 74.8%-91.0%] and 80.8% [95%CI： 65.7%-95.9%] respectively.The diagnostic accuracy was 82.4% [95%CI： 75.2%-89.6%].The sensitivity and specificity of combination determination of IMA and H-FABP were 96.3% [95%CI： 96.2%-100.0%] and 80.8% [95%CI： 65.7%-95.9%] respectively.The diagnostic accuracy was 92.6% [95%CI： 87.7%-97.5%].The combination determination of IMA and H-FABP had a significant better sensitivity and diagnostic accuracy than the other biomarker assays（P〈0.05）.The positive predictive value and negative predictive value were 94.0% and 87.5% respectively.Conclusions The combination determination of IMA and H-FABP after initiation of chest pain may improve the diagnostic efficiency for ACS in patients without increased troponin T level.