心肌损伤标记物水平在不同类型冠心病中的观察研究

Myocardial injury marker levels in different coronary heart diseases

目的研究不同心肌损伤标记物诊断早期急性心肌梗死(AMI)的意义。方法选择胸痛患者60例,AMI组32例,UAP组18例,SAP组10例,ELISA法测定患者胸痛<3h,3～6h血心型脂肪酸结合蛋白(H-FABP)、单核细胞趋化蛋白1(MCP-1)、凝血酶原片段(F1+2)浓度变化,同时检测肌钙蛋白I(cTnI)和肌红蛋白(MYO)。分析胸痛<3h,≤6hH-FABP、MCP-1、F1+2诊断AMI的敏感性和特异性。结果与AMI组比较,UAP组和SAP组胸痛<3h,3～6h血浆H-FABP、MCP-1、F1+2、cTnI及MYO明显下降(P<0.05,P<0.01);与UAP组比较,SAP组胸痛<3h,3～6h血浆MCP-1、F1+2明显下降(P<0.05)。在胸痛<3h,≤6hH-FABP敏感性高于其他指标;胸痛<3h,≤6hH-FABP特异性均与cTnI相似,高于其他指标。胸痛≤6hF1+2及MCP-1敏感性、特异性较胸痛<3h明显升高,F1+2敏感性与MYO相似,但MCP-1敏感性与MYO相比仍较低。结论 H-FABP在时效方面更早于cTnI,总体诊断价值要优于cTnI,有望成为理想的早期诊断AMI的生化标记物。

Objective To study the value of different myocardial injury markers in early diagnosis of AMI. Methods Sixty chest pain patients were divided into into AMI group （n = 32）, UAP group （n = 18）, SAP group （n = 10）. Their serum H-FABP, MCP-1, prothrombin activation FI＋2,cTnI,MYO levels were measured 〈3 and 3-6 h after the occurrence of chest pain by ELISA and the sensitivity and specificity of H-FABP,MCP-1,and F1＋2 were analyzed. Results The serum H-FABP, MCP-1, F1 ＋ 2, cTnI and MYO levels were significantly lower in UAP and SAP groups than in AMI group 3 and 3-6 h after the occurrence of chest pain （P〈0. 05,P〈0.01）. The serum H-FABP and F1＋2 levels were significantly lower in SAP group than in UAP group 3 and 3-6 h after the occurrence of chest pain （P〈0.05）. The sensitivity of H-FABP was significantly higher than that of MCP-1,F1＋2,and MYO 〈3 and ≤6 h after the occurrence of chest pain. However,no significant difference was found in the specificity of H FABP and cTnI 3 and ≤6 h after the occurrence of chest pain. The sensitivity and specificity of F1＋2 and MCP-1 were significantly higher ≤6 h after the occurrence of chest pain than 〈3 h after the occurrence of chest pain. No significant difference was found in the sensitivity and specificity of F1＋2 and MYO,but the sensitivity of MCP-1 was lower than that of MYO 〈6 and 〈3 h after the occur- rence of chest pain. Conclusion The overall value of H-FABP is superior to cTnI in early diagno sis of AMI and can thus be expected as an ideal biochemical marker for early AMI.