心肌脂肪酸结合蛋白对极早期非ST段抬高急性冠状动脉综合征危险分层的价值

THE PREDICTING VALUE OF H-FABP ON RISK STRATIFICATION IN PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROME

目的研究心肌脂肪酸结合蛋白对极早期非ST段抬高急性冠状动脉综合征(non-ST elevation acute coronary syndrome,NSTEACS)危险分层的价值。方法收集2010年9月—2011年11月因胸痛≤6h的急诊胸痛患者130例,分为高危NSTEACS组64例(非ST段抬高急性心肌梗死44例,高危不稳定性心绞痛20例),非高危NSTEACS组53例(中危不稳定性心绞痛16例,低危不稳定性心绞痛20例,稳定性心绞痛17例),非心源性胸痛组13例。分别在发病后0～3h、>3～6h内采用快速检测法检测心肌脂肪酸结合蛋白和肌钙蛋白I,同时比较各项指标在各组不同发病时间段的灵敏度、特异度、阳性预测值和阴性预测值。结果高危NSTEACS组心肌脂肪酸结合蛋白阳性率(90.6%)明显高于其他组,差异有统计学意义(P<0.01)。心肌脂肪酸结合蛋白灵敏度和阴性预测值在0～3h(66.7%、85.2%)和>3～6h(97.3%、91.9%)时间段显著高于肌钙蛋白I,差异有统计学意义(P<0.05)。在0～6h内,其特异度与肌钙蛋白I比较,差异无统计学意义(P>0.05)。结论肌脂肪酸结合蛋白是早期心肌损伤严重程度的判断指标,在非ST段抬高急性冠状动脉综合征极早期的危险分层中有重要的临床应用价值,更适用于广大基层医院急诊高危急性冠状动脉综合征的筛查。

Objective To investigate the predicting value of heart-type fatty acid binding protein（H-FABP） on the early risk stratification in patients with non-ST elevation acute coronary syndrome（NSTEACS）. Methods A total of 130 patients with acute chest pain lasting ≤ 6h before admission from September 2010 to November 2011 were enrolled in this study. All patients were divided into high-risk NSTEACS group including 44 patients with non-ST elevation acute myocardial infarction （NSTEMI） ,20 patients with high-risk unstable angina pectoris（ high-risk UAP） ;non-high-risk NSTEACS group including 16 patients with middle-risk UAP,20 patients with low-risk UAP, 17 patients with stable angina （SAP） ,and 13 patients with non-cardiac chest pain（NCCP）. H-FABP,cardiac troponin I （cTnI） levels of all groups were detected and analyzed synchronously within 3 hours and 6 hours. The data of sensitivity, specificity, positive predictive value and negative predictive value was obtained and calculated. Results H-FABP positive rate was 90.6% in the group of high-risk NSTEACS, which was higher than those of other groups （ all P 〈 O. 01 ）. The sensitivity and negative predictive value of H-FABP within 3 hours （ 66.7%, 85, 2% ） were higher than that of cTnI （ P 〈 0, 05 ）; The＇ sensitivity andnegative predictive Value of I-I-FABP within 3 -6 hours （97.3% ,91.9% ）were also higher than that of cTnI （P 〈 O. 05 ） ; The difference between the specificity of H-FABP and cTnI was not statistically significant （P 〉 O. 05 ） within 6 hours. Conclusion Plasma H-FABP level can be an early diagnostic marker for myocardial necrosis or damage within early stage, reflect critical clinical value for the risk stratification of early NSTEACS （within 6 hours） ,and may be applicable for use in the early screening of risk ACS in the majority of primary hospital emergency.