心型脂肪酸结合蛋白检测对早期心肌损伤辅助诊断的临床价值

The value of the Heart-type Fatty Acid Binding Protein(H-FABP)to diagnosis of the early myocardial injury

目的探讨心型脂肪酸结合蛋白（H-FABP）检测对早期心肌损伤辅助诊断的临床价值。方法选择2014年5月至2015年7月确诊为心肌损伤68例患者作为患者组,分为不稳定型心绞痛组（A组）、非ST段抬高心肌梗死组（B组）、ST段抬高心肌梗死组（C组）,3个小组,选择同期进行健康体检且健康者25例作为健康对照组。检测所有研究对象的血清H-FABP、缺血修饰清蛋白（IMA）、肌红蛋白（MYO）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）浓度。结果与健康对照组比较,患者组患者在入院早期（3~6h）和中晚期（〉6~12h）2次检测血清HFABP、IMA、MYO、CK、CK-MB的浓度均明显升高,差异有统计学意义（P〈0.05）,但A、B、C 3组间H-FABP浓度差异并无统计学意义（P〉0.05）;A、B、C 3组患者在入院早期检测血清H-FABP、IMA、MYO的阳性率均超过80.00%,明显高于CK和CK-MB的阳性率,差异有统计学意义（P〈0.05）,但血清H-FABP、IMA、MYO在3组间的阳性率差异无统计学意义（P〉0.05）;A、B、C 3组患者在入院中晚期检测该5项指标,阳性率均超过80.00%,5项指标阳性率分别两两比较,差异均无统计学意义（P〉0.05）。早期和中晚期H-FABP检测结果与确诊结果的Kappa一致性分析显示,结果分别为0.80（P〈0.05）和0.95（P〈0.05）。结论 H-FABP对心肌损伤患者的早期诊断具有一定的临床价值,较高的灵敏度和特异度适用于心肌损伤的筛查,能有效降低漏诊率和误诊率。

Objective To explore the clinical value of H-FABP testing to the diagnosis of early myocardial injury and to provide reference for clinical diagnosis and treatment.Methods 68 cases of patients with the myocardial injury were chosed as the experimental group,which had divided into three groups,the unstable angina group（A group）,the non-ST segment elevated myocardial infarction group（B group）and the ST elevation myocardial infarction group（C group）,and 25 cases healthy check-up was choosed as the control group.The H-FABP,IMA,MYO,CK and CK-MB in serum were tested and were analyzed.Results Compared with the control group,there were significantly higher for H-FABP,IMA,MYO,CK and CK-MB in the serum of the experimental group results both in early（3-6hours）and mid-late（6-12hours）term（P〈0.05）,but there was no obvious difference of the H-FABP among the ABC group（P〉0.05）.The positive rate about H-FABP,IMA and MYO in the serum of the patients which had early enterd the hospitalall was more than 80.00%,and all was higher than the CK and CK-MB（P〈0.05）,but there were no obvious difference among these three indicators（P〉0.05）.There were no obvious difference among these five indicators of the positive rate of the patients which had mid-late enterd the hospital（P〉0.05）,and the positive rate of these five indicators in the patients was more than 80.00%.Comparing with the gold standard,the Kappa of the H-FABP in the rarly term and mid-late term results and the clinical diagnosis were 0.80（P〈0.05）and 0.95（P〈0.05）.Conclusion There may be significance to the H-FABP for the diagnosis of early myocardial injury.