心型脂肪酸结合蛋白在急性心肌梗死早期诊断价值的研究

Clinical value of heart - type fatty acid binding protein in the diagnosis of acute myocardial infarction

目的探讨心型脂肪酸结合蛋白（H-FABP）在急性心肌梗死（AMI）早期的诊断价值。方法选择急诊胸痛可疑心肌梗死人院患者68例，根据患者的临床症状、心电图及冠状动脉造影结果将患者分为不稳定型心绞痛组（UAP组，共22例）和AMI组（共46例）。分别在患者胸痛发生后3h和6h抽取静脉血5mL，ELISA法定量测定血清H-FABP浓度。分别计算H-FABP在AMI诊断中的敏感度、特异度、阳性预测值及阴性预测值，并与hsTnT、CK-MB的诊断效能进行比较。结果AMI组在胸痛发生后3h和6h血清H-FABP浓度明显大于UAP组（P〈0．05）。胸痛后3hH-FABP用于检测AMI的敏感度、特异度、阳性预测值、阴性预测值分别为87．0％、81．8％、90．9％、75．0％，胸痛后6h分别为95．7％、90．9％、95．7％、90．9％。其中6h组除阳性预测值外均明显高于3h组（P〈0．05）。H-FABP用于检测AMI的敏感度和阴性预测值明显高于hsTnT和CK-MB（P〈0．05）。结论AMI患者血清H-FABP浓度明显增加，H-FABP用于早期诊断AMI具有良好的敏感度和特异度，其中以胸痛发生后6h的敏感度和特异度较高。

Objective To investigate the value of heart - type fatty acid binding protein （ H - FABP） in the early diagnosis of acute myocardial infarction（AMI）. Methods 68 patients admitted to hospital with acute chest pain were selected in this study, and were divided into unstable angina pectoris （UAP） group and acute myocardial infarction （AMI）group according to the clinical diagnosis including ECG and the results of coronary arteriography. Serum H - FABP concentrations were tested by using ELISA method at 3 h （ H - FABP3 ） and 6 h （ H - FABP6 ） after the chest pain. The sensitivity, specificity, positive predictive value, negative predictive value were compared with hsTnT and CK - MB. Results Serum H - FABP3 and H - FABP6 concentrations were significantly higher in group AMI than in group UAP （ P 〈 0. 05 ）. The sensitivity, specificity, positive predictive value, negative predictive value of H - FABP3 in the diagnosis of AMI were 87.0% , 81.8% , 90.9%, 75.0% , while in H - FABP6 were 95.7% ,90.9% ,95.7% ,90.9%. The data of H - FABP6 were significantly higher than those of HABP3 except positive predictive value （ P 〈 0.05 ） ; Further, the sensitivity and negative predictive value of H - FABP were significantly higher than those of hsTnT and CK - MB （ P 〈 O. 05 ）. Conclusion The serum H - FABP concentrations of patients were significantly increased at the early stage of AMI. The sensitivity and specificity of H - FABP in the early diagnosis of AMI were significantly higher than those of hsTnT and CK - MB.