心脏型脂肪酸结合蛋白在急性心肌梗死早期诊断中的优势

Heart Type Fatty Acid Binding Protein in Early Diagnosis of Acute Myocardial Infarctionadvantage

目的：研究心肌型脂肪酸结合蛋白（H-FABP）对急性心梗患者早期诊断中的优势,比较不同心脏标志物诊断AMI的价值.方法：选择2013年1月-2014年1月于某院心血管内科就诊,胸骨后疼痛发作12d内但未确诊为急性心梗的患者165例,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种心脏标志物以及各种标志物间联合运用在诊断急性心肌梗死（AMI）的灵敏度、特异度.在AMI组内,按照胸痛发作的时间不同,分为〈2h组,2-4h组,4-6h组,〉6h组,分别对不同组H-FABP、cTnT 及CK-MB阳性结果进行比较.结果：H-FABP对AMI的诊断灵敏度（85.0%）高于cTnT（61.25%）和CK-MB（53.75%）以及cTnT和CK-MB的联合应用（65.0%）.单-运用H-FABP与联合运用H-FABP和其他标志物诊断AMI的灵敏度无统计学差异.所有指标的特异度均无统计学意义（P〉0.05）.对于起病2h内的AMI患者,H-FABP的阳性率（66.67%）显著优于CK-MB（16.67%,P〈0.05）和cTnT（25%,P〈0.05）;对于起病2-4h内的AMI患者,H-FABP的阳性率（81.82%）显著优于CK-MB（45.45%,P〈0.05）和cTnT（50%,P〈0.05））;对于起病4-6h内的AMI患者,H-FABP的阳性率（100%）优于CK-MB（77.78%,P〈0.05）和cTnT（88.89%,P〈0.05）;对于起病6h以上的AMI患者,H-FABP的阳性率与CK-MB和cTnT无明显统计学差异.将同一检测指标不同起病时间段的阳性率比较显示：H-FABP在〈2h（66.67%）与2-4h（81.82%）2个时段无显著差异,但低于4-6h段及〉6h段（100%,P〈0.05）.结论：H-FABP早期诊断急性心肌梗死（尤其是4h内）较CK-MB和cTnT具有更重要的价值.

Objective:To study the heart type fatty acid binding protein (H‐FABP) in early diagnosis of a‐cute myocardial infarction patients in advantage ,comparison of different cardiac markers in the diagnosis of AMI value .Methods:2013 January to 2014 January in the treatment of cardiovascular department of internal medicine in our hospital ,retrosternal pain episodes in 12 but not in 165 patients diagnosed asacute myocardial infarction patients ,immediate recovery elbow venous blood 5ml .Using rapid test kit (colloidal gold method) to detect H‐FABP ,simultaneous determination of cardiac troponin T (cTnT ) and creatine kinase MB (CK‐MB) .Using SPSS17 .0 software ,comparison of 3 kinds of cardiac markers and a variety ofmarkers between the joint application in the diagnosis of acute myocardial infarction(AMI) sensitivity ,specificity .In the AMI group ,according to the different time of chest pain onset ,divided into <2 hour group ,group 2~4 hours ,&nbsp;4~6 hours group ,> 6 hours group ,respectively ,to compare different groups of H‐FABP ,CTNT and CK‐MB positive .Results:The diagnostic sensitivity of H‐FABP on the results of AMI (85% ) was higher than that of cTnT (61 .25% ) and CK‐MB (53 .75% ) and the combined application of cTnT and CK‐MB (65% ) . No significant difference in sensitivity of singleusing H‐FABP and combined use of H‐FABP and other mark‐ers in the diagnosis of AMI .The specificity of all indexes had no statistical significance (P>0 .05) .For the 2hours of onset in AMI patients ,the positive rate of H‐FABP (66 .67% ) was higher than that of CK‐MB (16 .67% ,P<0 .05) and cTnT (25% ,P<0 .05);for the onset of 2~4hours of AMI patients ,the positive rate of H‐FABP (81 .82% ) was higher than that of CK‐MB (45 .45% , P< 0 .05) and cTnT (50% , P<0 .05);for the onset of 4~6 hours of AMI patients ,the positive rate of H‐FABP (100% ) than CK‐MB (77 .78% ,P<0 .05) and cTnT (88 .89% ,P<0 .05);for more than 6 hours of the onset of AMI patients , H‐FABPwas positive in 0 and the rate of CK‐MB and cTnT has no obvious statisticaldifference .The positive rate of the same detection index of different onset time period comparison show s :H‐FABP in less than 2 hours (66 .67% hours) and 2~4(81 .82% ) did not differ significantly between the two time periods ,but less than 4~6and > 6 small time interval (100% , P<0 .05) .Conclusion:Early diagnosis of acute myocardial in‐farction H‐FABP (especially 4 hours) than the CK‐MB and cTnT has amore important value .