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心脏型脂肪酸结合蛋白和D-二聚体及高敏肌钙蛋白T在急性冠状动脉综合征早期诊断中的应用 被引量:19

Human heart-type fatty acid-binding protein,D-dimer and High-sensitive cardiac troponin T in the early diagnosis of acute coronary syndrome
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摘要 目的探讨心脏型脂肪酸结合蛋白(human heart-type fatty acid-binding protein,h-FABP)、D-二聚体(D-dimer)及超敏肌钙蛋白T(high-sensitive cardiac troponin T,hs-c Tn T)对急性冠脉综合征(acute coronary syndrome,ACS)的早期诊断价值。方法收集2014年3月至2015年5月东莞市常平医院急诊科157例胸痛患者、50名健康体检者(健康对照组)的静脉血,分离得血清及血浆。测定所有研究标本的h-FABP、D-二聚体和hs-c Tn T。所有实验数据均通过SPSS13.0软件进行统计学处理。结果 ACS患者中的不稳定性心绞痛(unstable angina,UA)组、非ST段抬高心肌梗死(non-ST-elevation myocardial infarction,NSTEMI)组、ST段抬高心肌梗死(ST-elevation myocardial infarction,STEMI)组血清h-FABP水平、血浆D-二聚体水平、血清hs-c Tn T水平均高于非缺血性胸痛(non-ischemic chest pain,NICP)组和健康对照组,差异具有统计学意义(P=0.002)。胸痛3 h以内组和3~6 h组ACS患者血清h-FABP水平均高于健康对照组,差异具有统计学意义(P=0.003)。胸痛3~6 h组ACS患者血浆D-二聚体、血清hs-c Tn T水平均高于健康对照组,差异具有统计学意义(P=0.005)。单独应用h-FABP诊断ACS(胸痛3~6 h)的敏感度为87.07%,特异度为73.62%,准确性为82.03%。h-FABP、D-二聚体及hs-c Tn T联合应用诊断ACS(胸痛3~6 h)的敏感度为97.41%,特异度为59.22%,准确性为87.65%。结论血清h-FABP是ACS发病早期心肌缺血的敏感指标,优于hs-c Tn T和血浆D-二聚体对ACS发病早期的心肌缺血诊断作用。联合检测h-FABP、D-二聚体及hs-c Tn T可提高诊断的敏感性和准确性,对指导临床早期诊断ACS有一定价值。 Objective To investigate the value of early diagnosis of human heart-type fatty acidbinding protein(h- FABP),D- dimerand high- sensitive cardiac troponin T(hs- c Tn T)in acute coronary syndrome(ACS). Methods All 157 blood samples of patients with chest pain in the emergency department of the Dongguan City Changping Hospital were selected. 50 healthy individuals were selected as the control group.h-FABP,D-dimer and hs-c Tn T were measured in all the specimens. All the experimental data were statistically processed by SPSS 13.0 statistical software. Results The levels of h-FABP,D-dimer,hs-c Tn T in the ACS group,which includes the unstable angina(UA)group,non-ST-elevation myocardial infarction(NSTEMI)group,and ST- elevation myocardial infarction(STEMI)group,were significantly higher than those of the non- ischemic chest pain(NICP)group and control group. There were significant differences between the ACS group and the NICP group and the control group(P=0.002). The levels of h-FABP in the ACS group between 3 to 6 h,were significantly higher than that of the controls(P=0.003). The levels of D-dimer and the hs-c Tn T in the group between 3 to 6 h were significantly higher than those of the controls(P=0.005). The sensitivity,specificity and accuracy was 87.07%,73.62% and 82.03% of the h-FABP in a separate diagnosis of ACS(chest pain for 3~6 h),but the sensitivity,specificity and accuracy were 97.41%,59.22%and 87.65% of the h-FABP,D-dimer and the hs-c Tn T with the affiliation diagnosis(Chest pain for 3~6 h).Conclusion The serum h-FABP is a more sensitive indicator of ACS in early myocardial ischemia than hs-c Tn T and plasma D-dimer. Serum h-FABP in combination with D-dimer and hs-c Tn T could improve sensitivity and accuracy,which are valuable to guide clinical diagnosis of ACS in early stages.
出处 《分子诊断与治疗杂志》 2016年第3期182-187,共6页 Journal of Molecular Diagnostics and Therapy
关键词 急性冠状动脉综合征 心脏型脂肪酸结合蛋白 D-二聚体 高敏肌钙蛋白T Acute coronary syndrome Human heart-type fatty acid-binding protein D-dimer High-sensitive cardiac troponin T
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