心型脂肪酸结合蛋白和N末端B型利钠肽同时检测在急性心力衰竭早期诊断中的价值

The Value of the Simultaneous Detection with Heart Fatty Acid Binding Protein and N Terminal B Type Natriuretic Peptide in the Early Diagnosis of Acute Heart Failure

目的探讨同时检测N末端B型利钠肽(NT-proBNP)和心型脂肪酸结合蛋白(H-FABP)在急性心力衰竭(heart failure,HF)患者早期诊断中的价值。方法选取2016年1—9月在自贡市第三人民医院心血管内科住院,并明确诊断为急性HF的患者138例(HF组);选择同期在心血管内科就诊,有相似症状但最终排除HF的60名患者作为正常对照组。同时检测两组患者发病3h内和3h后的血清NT-proBNP和血清H-FABP水平。结果在发病3h内,HF组NT-proBNP水平为(345.00±29.84)pg/mL,H-FABP水平为(42.26±20.23)ng/mL,明显高于对照组的NT-proBNP水平:(46.00±22.62)pg/mL,H-FABP水平:(5.03±1.47)ng/mL;同时检测NT-proBNP和H-FABP的阳性率为98.55%,敏感度为95.23%,特异性为99.12%,诊断符合率为99.87%,阳性预示值为98.27%,阴性预示值为99.99%,明显高于单独检测NT-proBNP的91.30%,90.13%,98.99%,99.10%,97.13%,99.00%和H-FABP的95.23%,84.11%,94.62%,90.96%,93.02%,89.63%,且差异有统计学意义(P<0.05)。结论在急性心力衰竭早期(3h内),同时检测H-FABP和NT-proBNP具有较高的诊断符合率、敏感度及阴性预示值,有利于提高急性HF的早期诊断。

Objective To investigate the value of the simultaneous detection with N terminal B type natriuretic peptide （NT-proBNP）and heart fatty acid binding protein （H-FABP）in the early diagnosis of patients with acute heart failure （HF）.Methods 138 patients hospitalized in Zigong Third People＆#39;s Hospital from January to September of 2016 and diagnosed with acute heart failure were selected and divided into the HF group,and the other 60 synchronous inpatients with similar symptoms but no heart failure were selected and divided into the control group.The serum NT-proBNP and H-FABP of all the patients in the two groups were detected simultaneously within 3 hours after onset and 3 hours later respectively.Results Within 3 hours after onset,the level of NT-proBNP was （345.00＆#177;29.84）pg/mL and that of H-FABP was （42.26＆#177;20.23）ng/mL in the HF group,while the level of NT-proBNP was （46.00＆#177;22.62）pg/ml and that of H-FABP was （5.03＆#177;1.47）ng/mL.The rates of positivity,sensitivity,specificity,and diagnostic accuracy in the simultaneous detection were 98.55%,95.23%, 99.12%,and 99.87% respectively,those in the single detection of NT-proBNP were 91.30%,90.13%,98.99%, 99.10%,and those in the single detection of H-FABP were 95.23%,84.11%,94.62%,90.96%.The positive and negative predicative values in the simultaneous detection were 98.27% and 99.99% respectively,those in the single detection of NT-proBNP were 97.13% and 99% respectively,and those in the single detection of H-FABP were 93.02% and 89.63% respectively.The rates and values of the simultaneous detection were significantly higher than those of the single detection of NT-proBNP and H-FABP （P〈0.05）.Conclusion In the early stage of acute heart failure,the simultaneous detection of H-FABP and NT-proBNP has high diagnostic accuracy,sensitivity and negative predictive value,and it is helpful to improve the early diagnosis of acute heart failure.