心肌型脂肪酸结合蛋白与cTnT、CK—MB组合诊断早期急性冠脉综合征的比较

Comparison of human heart-type fatty acid-binding protein used as an early diagnostic cardiac marker of acute coronary syndrome with combination of cardiac troponin-T and creatine kinase- myocardial band

目的研究心肌型脂肪酸结合蛋白（H—FABP）对早期急性冠脉综合征（ACS）的诊断价值，比较不同心脏标志物联合检测诊断ACS的价值。方法选择2010年4月至2011年6月因胸痛发作6h内就诊于北京大学第三医院急诊科的疑似ACS患者103例，就诊即刻采肘静脉血5ml。采用快速检测试剂盒（胶体金法）检测H—FABP，同时测定肌钙蛋白T（cTnT）和肌酸激酶同工酶MB（CK—MB）。采用SPSS17．0软件比较3种心脏标志物及不同心脏标志物组合在诊断急性心肌梗死（AMI）的灵敏度、特异度、阳性预测值和阴性预测值以及不同时间段诊断AMI的灵敏度和特异度。结果在ACS发病6h内，H-FABP对AMI的诊断灵敏度（62．5％）高于cTnT（30．6％）和CK—MB（33．3％），差异具有统计学意义（P〈0．01），特异度和阳性预测值差异无统计学意义。H—FABP＋cTnT组合的阴性预测值最高（53．8％）。H—FABP在AMI发病3—6h的灵敏度（77．8％）高于发病0～3h（53．3％），差异具有统计学意义（P=0．038）。在AMI发病0—3h，H—FABP＋cTnT组合和H—FABP＋CK—MB组合的诊断灵敏度（55．6％）高于cTnT＋CK—MB组合（24．4％），差异具有统计学意义（P：0．003）。在发病0～3h和3～6h，H-FABP＋cTnT组合诊断灵敏度高于单一检测H—FABP（分别提高3．3％和7．4％），H—FABP＋cTnT组合的诊断灵敏度在发病3～6h最高（85．2％）。结论H—FABP是目前早期（0～6h）诊断ACS最敏感的心脏生化标志物，尤以发病3—6h更为敏感。H—FABP＋cTnT组合比单一检测H—FABP的诊断灵敏度高，发病3～6h的H—FABP＋cTnT组合具有最好的诊断价值。

Objective To evaluate the early diagnostic value of human heart-type fatty acid- binding protein （H-FABP） of acute coronary syndrome （ACS） and compare the diagnostic accuracy of different combination regimens of cardiac markers. Methods A total of 103 consecutive patients with chest pain （within 6 h after admission to Peking University Third Hospital, emergency department） suggestive of ACS were recruited for the analysis from April, 2010 to June, 2011. The blood levels of H-FABP, cardiac troponin-T （cTnT） and creatine kinase-myocardial band （CK-MB） were obtained at admission. The sensitivity, specificity, positive predictive value and negative predictive value together with the sensitivity and specificity in different phases of illness at admission were analyzed and compared among H-FABP, cTnT, CK-MB and different combinations by using SPSS version 17.0 software. Results Within 6 h of onset of symptom, the overall sensitivities of H-FABP, cTnT and CK-MB were 62. 5% , 30. 6% and 33.3% respectively for patients with ACS. The sensitivity of H-FABP was significantly higher than that of cTnT and CK-MB （P 〈 0. 01 ）. There were no differences in specificity and positive predictive value. The combination of H-FABP with cTnT had the greatest negative predictive value （53.8%）. The sensitivity of H-FABP was higher during 3 -6 h （77.8%） than during 0 -3 h （53.3%） after chest pain onset （P =0. 038）. Within 0 - 3 h of onset of AMI, the overall sensitivities of the combination of H-FABP with eTnT and H-FABP with CK-MB （55.6%） were significantly higher than the eombinaton of cTnT with CK-MB （24. 4% ） （P = 0. 003）. The sensitivity of the combination of H-FABP with eTnT was higher than that of single H-FABP during 0 - 3 h and 3 - 6 h after onset of AMI with increment in 3.3% and 7.4% respectively. The combination of H-FABP with eTnT had the greatest sensitivity （85.2%） during 3 - 6 h after onset. Conclusions H-FABP is the most sensitive cardiac marker in diagnosing of ACS in the early phase within 6 h, especially during 3 - 6 h after onset . The sensitivity of the combination of H-FABP with eTnT is higher than that of H-FABP alone. The combination of H-FABP with cTnT has the best diagnostic value during 3 - 6 h after onset of ACS.