心脏型脂肪酸结合蛋白（H-FABP）在早期诊断急性心肌梗死中的价值

the Diagnostic Efficacy of The Rapid Heart-fatty Acid-binding Protein Test in Patients with Early Acute Myocardial Infarction

目的观察心脏型脂肪酸结合蛋白（H—FABP斟佥测试剂盒《胶体金方法）用于临床早期诊断急性心肌梗死（AMI）的价值。方法检测发病12h内入院的疑似冠心病和心肌梗死患者，在所有病例入院即刻采集血样，用心脏型脂肪酸结合蛋白（H-FABP）检测试剂盒进行全血定性检测，同时测定血清心肌肌钙蛋白T（cTnT）、肌酸激酶同工酶（CK—MB）水平。参照标准诊断结果，比较上述心肌损伤标志物诊断AMI的敏感性和特异性。结果①共入选患者227例，最终确诊AMI者114例，非心肌梗死者113例，其中不稳定型心绞痛（UAP）27例，稳定型心绞痛（SAP）20例，非心源性胸痛者（NCCP）24例，健康体检者42例。AMI患者入院时平均胸痛时间为0．96±3．08）h，其中胸痛3h（2.03±0．80h）内入院者38例，3-6h（4．44±0．68h）入院者44例，6-12h（9.16±2．01h）入院者32例；②H—FABP、CK—MB和cTnT检测A／VII的敏感性分别为92．98％、67．54％和69．30％；特异性分别为91．15％、96．46％和97．35％。单一采用H—FABP检测AMI的敏感性显著优于CK—MB（P〈0．O001）和cTnT（P〈0．0001）单一检测或二者联合检测（P〈0．001）的敏感性，且与H—FABP＋cTnT（94．7%）和H-FABP＋CK—MB＋cTnT（94．74%）联合检测的敏感性无显著差异。H—FABP检测AMI的特异性与CK—MB和cTnT相近p均〉0．05），与CK—MB＋cTnT（93．81％）、H—FABP＋cTnT（91．15％）及H—FABP＋CK—MB＋cTnT（8850％）联合检测的特异性无统计学差异；③对于起病3h内的AMI患者，H-FABP单一检测的敏感性（84121％）显著优于CK-MB（34．21％，P〈0．0001）和cTnT（3684％，p〈0．O001）单一检测或二者联合检测（50．00％，P〈0．01）的敏感性，且与H—FABP＋cTnT（86．84％）和H—FABP＋CK—MB＋cTnT（86．84%）联合检测的敏感性无显著差异。对于起病3—6h的AMI患者，H—FABP单一检测的敏感性（95．46％）亦显著优于CK—MB（72．73％，P〈0．01）和cTnT（7500％，P〈0．05）单一检测或二者联合检测（79．55％，P〈0．05）的敏感性，同样与H—FABP＋cTnT（97．73％）和H—FABP＋CK—MB＋cTnT（97．73％）联合检测的敏感性无显著差异。对于起病〉6h的AMI患者，H—FABP、CK—MB和cTnT单一或联合检测的敏感性均为100％；④将同一检测指标在不同起病时间段的检测敏感性比较显示：H—FABP在≤3h（84．21％）与3-6h（95．4696）二个时段的检测敏感性无显著差异，但低于〉6h时段的检测敏感性（100％，P〈0．05）。CK—MB在≤3h（34．21％）时段的检测敏感性显著低于3-6h（72．73％，P〈0．001）和〉6h（100％，P〈0．0001），cTnT、CK—MB＋cTnT在不同时段的检测结果与之一致。H—FABP＋cTnT和H—FABP＋CK—MB＋cTnT联合检测的敏感性在三个不同时段无显著差异。结论①H—FABP快速检测试剂盒暇体金方法）在AMI发生6h内比其是3h内）的诊断敏感性显著优于CK—MB及cTnT，且具有较高的心肌特异性；②心脏型脂肪酸结合蛋白（H—FABP）检测试剂盒彼体金方法）操作简单、快捷，对于及时、迅速地诊断急性心肌梗死具有重要的临床应用价值。

Objective To observe the efficacy of heart-type fatty-acid binding protein （H-FABP） for early diagnosis of AMI. Methods Doubtful coronary artery disease （CHD）and acute myoeardial infarction （AMI）consecutive patients admitted to the hospital within 12h after the onset of chest pain were recruited to the study. A rapid test kit for qualitative determination of H-FABP was employed to detect the whole blood H-FABP level in all patients at the time of admission. Serum tropaninT （eTnT） and creatine kinase-myoeardial band （CK-MB） were also measured simultaneously. Results ①227 patients were recruited to the study, 114 of them had a final diagnosis of AMI, 113 were excluded from AMI, among whom 27 were diagnosed as UAP, 20 as SAP, and 24 as non-cardiogenic chest pain. Tile average chest pain time of AMI patients were 4.96±3.08h,38 of them admitted within 3h（2.03±0.80h）,44 of them admitted within 3-6h（4,44±0.68h）, 32 of them admitted within 6-12h（9.16±2.01h）;②the sensitivity of H-FABP,CK-MB and eTnT in diagnosis of AMI were 92.98%,67.54% and 69.30% respectively, the specificity were 91.15%,96.46% and 97.35% respectively.The sensitivity of H-FABP was significantly higher than that of CK-MB（P〈0.0001）,eTnT（P〈0.0001） and CK-MB＋cTnT（P〈0.001）,similar with H-FABP＋cTnT（94.74%） and H-FABP＋CK-MB＋cTnT（88.50%） ; ③With regard to the AMI patients who admitted within 3h, the sensitivity of H- FABP （84.21%） was significantly higher than CK-MB（34.21%,P〈0.0001） ,eTnT（36.84%,P〈0.0001）and CK-MB＋cTnT（50.00%,P〈0.01）,similar with H-FABP＋eTnT（86.84%）and H-FABP＋CK-MB＋eTnT（86.84%）.With regard to the AMI patients who admitted within3-6h, the sensitivity of H-FABP （84.21%） also was significantly higher than CK-MB （72.73%,P〈0.01）,cTnT （75.00%,P〈0.05） and CK-MB＋cTnT （79.55%,P〈0.05）,similar with H- FABP＋eTnT （97.73%） and H-FABP＋CK-MB＋eTnT （97.73%）. With regard to the AMI patients who admitted within 〉6h,the sensitivity of H-FABP, CK-MB and eTnT were 100%; ④The sensitivity of H-FABP within 3h was similar with the sensitivity within3-6h,significantly lower than the sensitivity of H-FABP within 〉6h （100%,P〈0.05）,the sensitivity of CK-MB in ≤3h（34.21%） was significantly lower than that in 3-6h（72.73%,P〈 0.001） and in 〉6h （lO0%,P〈0.0001）.the result of eTnT and CK-MB＋eTnT was similar with the CK-MB,the sensitivity of H-FABP＋eTnT and H- FABP＋CK-MB＋eTnT were no significant deviation in the different time.Conclusion The rapid qualitative H-FABP test kit has higher sensitivity than CK-MB and eTnT in the diagnosis of AMI as early as within 6 hours of symptom onset （especially within 3 hours）,also has high speeificity.h can be used simplely and rapidly,So the rapid qualitative H-FABP test kit has high efficacy in the early diagnosis of AMI.