5项心肌标志物联合检测对先兆子痫心肌损伤的诊断价值研究

Diagnostic value of five several myocardial markers combined detection in preeclampsia

目的探讨超敏肌钙蛋白-T(hs-cTnT)、人心型脂肪酸结合蛋白(H-FABP)、B型尿钠肽(BNP)、缺血修饰清蛋白(IMA)和肌酸激酶同工酶(CK-MB)对先兆子痫心肌损伤的诊断价值。方法正常妊娠50例纳入妊娠组,诊断为先兆子痫167例为先兆子痫组,分为心肌损伤组42例和无心肌损伤组125例。另选择50例健康非妊娠女性为对照组。采用ELISA一步法测定血清中H-FABP,微粒子化学发光免疫法检测hs-cTnT和BNP,清蛋白-钴结合试验测定IMA,以及免疫抑制法测定CK-MB。结果先兆子痫组中心肌损伤组的CK-MB、H-FABP、IMA、hs-cTnT和BNP水平明显高于对照组、妊娠组和无心肌损伤组,差异有统计学意义[(t=8.521、7.489、7.256;7.561、6.897、6.235;12.314、9.236、10.251;13.657、11.023、12.031;11.301、10.364、15.567),(P=0.008,0.030,0.035;0.027,0.031,0.033;0.002,0.005,0.003;0.002,0.004,0.003;0.003,0.004,0.001)]。先兆子痫组中无心肌损伤组的CK-MB和hs-cTnT与对照组、妊娠组比较,差异无统计学意义[(t=1.678、1.401;1.887、1.784),(P=0.339、0.401;0.289、0.398)]。无心肌损伤组和妊娠组的IMA、H-FABP和BNP明显高于对照组[(t=4.784、4.021;3.894、3.784;5.801、5.215),(P=0.024、0.032;0.037、0.041;0.021、0.029)]。无心肌损伤组的IMA、H-FABP和BNP与妊娠组比较,差异无统计学意义[(t=1.325、1.257、1.241);(P=0.451、0.329、0.378)]。5项标志物联合检测灵敏度明显高于单个标志物(χ2=3.021、3.561、4.215、4.496、5.249;P=0.027、0.024、0.019、0.015、0.009)。结论采用心肌标志物判断孕妇心肌损伤时,应考虑到妊娠这一特殊的生理周期,5项心肌标志物联合检测,有利于早期诊断先兆子痫的缺血性心肌损伤。

Objective To investigate the value of high sensitive cardiac troponin T（hs-cTnT）,human heart fatty acid binding protein（H-FABP）,B-type natriuretic peptide（BNP）,ischemia modified albumin（IMA）and creatine kinase（CK-MB）in the diagnosis of myocardial injury in preeclampsia.Methods A total of 50 women of normal pregnancy in preganancy group,and 50 healthy women without pregnacy were collected in control group,167 women in preeclampsia group（42cases with myocardial injury,125 cases without myocardial injury）.The serum IMA were detected by albumin cobalt binding test,H-FABP were detected by ELISA,hs-cTnT and BNP were detected by microparticle chemiluminescence immunoassay and CK-MB were detected by immuno-suppression.Results Five cardiac markers levels in myocardial injury group of preeclampsia group were significantly higher than those in healthy control group and normal pregnancy women and non myocardial injury group[（t=8.521,7.489,7.256;7.561,6.897,6.235;12.314,9.236,10.251;13.657,11.023,12.031;11.301,10.364,15.567）,（P=0.008,0.030,0.035;0.027,0.031,0.033;0.002,0.005,0.003;0.002,0.004,0.003;0.003,0.004,0.001）].There was no significant difference in hs-cTnT among control group and normal pregnancy women and non myocardial injury group[（t=1.678,1.401;1.887,1.784）,（P=0.339,0.401;0.289,0.398）].IMA、H-FABP、CK-MB and BNP in normal pregnancy women and non myocardial injury group were higher than in control group[（t=4.784,4.021;3.894,3.784;5.801,5.215）,（P=0.024,0.032;0.037,0.041;0.021,0.029）].There was no significant difference in IMA,H-FABP,CK-MB and BNP between normal pregnancy women and non myocardial injury group [（t=1.325,1.257,1.241）;（P=0.451,0.329,0.378）].The sensitivity of combined detection of five cardiac markers in preeclampsia myocardial injury was significantly higher than that in single marker（χ2=3.021,3.561,4.215,4.496,5.249;P=0.027,0.024,0.019,0.015,0.009）.Conclusion When myocardial damage in pregnant women was determined by cardiac markers,pregnancy should be taken into account as a special physiological cycle.The combined detection of five cardiac markers is conducive to early diagnosis of ischemic myocardial injury in preeclampsia.