缺血修饰白蛋白和心型脂肪酸结合蛋白对急性冠状动脉综合征患者早期诊断价值

Value of ischemia-modified albumin and heart type fatty acid-binding protein to the early diagnosis of acute coronary syndrome

目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)检测血清缺血修饰白蛋白(ischemia-modified albumin,IMA)、心型脂肪酸结合蛋白(heart type fatty acid-binding protein,H-FABP)对其早期诊断的价值。方法因胸痛拟诊冠心病患者114例,其中非缺血性胸痛(non-ischemic chest pain,NICP)患者34例为NICP组,不稳定型心绞痛(unstable angina,UA)患者41例为UA组,急性心肌梗死(acute myocardial infarction,AMI)39例为AMI组,62例体检健康者为对照组;分别检测NICP组、UA组、AMI组胸痛发作3、6h血清中IMA、H-FABP及心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnⅠ)水平,并与对照组进行比较。绘制ROC曲线图评估IMA、H-FABP、cTnⅠ以及IMA与H-FABP联合对ACS的诊断效能。结果胸痛发作3、6h,AMI组患者血清IMA[(87.48±16.17)、(92.63±14.70)u/mL]、H-FABP水平[(24.06±13.12)、(28.83±13.33)μg/L]均高于UA组[IMA(80.00±11.91)、(84.21±13.01)u/mL、H-FABP(17.19±6.11)、(18.96±6.95)μg/L]、NICP组[IMA(66.18±13.23)、(67.68±13.30)u/mL、H-FABP(2.97±1.18)、(3.35±1.23)μg/L]和对照组[IMA(63.40±8.83)u/mL、H-FABP(3.22±1.24)μg/L](P<0.05),UA组高于NICP组和对照组(P<0.05),NICP组与对照组比较差异无统计学意义(P>0.05);胸痛发作3h时AMI组、UA组、NICP组和对照组血清cTnⅠ水平比较差异均无统计学意义(P>0.05),胸痛发作6h时AMI组血清cTnⅠ水平[(0.436±0.359)μg/L]高于UA组[(0.041±0.037)μg/L]、NICP组[(0.033±0.029)μg/L和对照组[(0.031±0.018)μg/L](P<0.05),UA组、NICP组和对照组血清cTnⅠ水平比较差异均无统计学意义(P>0.05);胸痛发作3、6h,血清IMA和H-FABP检测对ACS诊断的灵敏度[IMA(82.5%、85.9%)、H-FABP(81.3%、83.3%)]、阴性预测值[IMA(65.8%、72.1%)、H-FABP(69.4%、74.5%)]均明显高于cTnⅠ[灵敏度(10.0%、62.8%)、阴性预测值(30.8%、55.4%)](P<0.05),且IMA联合H-FABP检测诊断ACS的灵敏度(97.5%、98.7%)、阴性预测值(93.1%、96.9%)均高于IMA、H-FABP、cTnⅠ单独检测(P<0.05);当IMA最佳截断值为77.8u/mL时,诊断ACS的AUC为0.843(95%CI:0.790～0.888),灵敏度为85.4%、特异度为77.9%;H-FABP诊断ACS的AUC为0.920(95%CI:0.884～0.955),灵敏度为81.7%、特异度为100.0%。结论 IMA、H-FABP在心肌损伤早期(3h)即升高,检测IMA、H-FABP可对ACS进行危险分层,并排除NICP,联合检测IMA和H-FABP可提高诊断ACS的灵敏度。

Objective To explore the value of serum ischemia-modified albumin（IMA）and heart-type fatty acid binding protein（H-FABP）to the early diagnosis of acute coronary syndrome（ACS）.Methods Totally 114 patients with suspected coronary heart disease due to chest pain included 34 patients with non-ischemic chest pain（NICP）（NICP group）,41 patients with unstable angina（UA）（UA group）and 39 patients with acute myocardial infarction（AMI）（AMI group）.Another 62 healthy volunteers were as controls（control group）.The serum levels of IMA,H-FABP and cardiac troponin Ⅰ（cTnⅠ）were detected at 3 and 6 hafter chest pain attack in NICP,UA and AMI groups,and were compared with control group.The diagnostic efficacies of IMA,H-FABP,cTnⅠ and IMA plus H-FABP on ACS were evaluated by ROC curves.Results At 3 and 6 hafter chest pain attack,the serum levels of IMA（（87.48±16.17）,（92.63±14.70）u/mL）and H-FABP（（24.06±13.12）,（28.83±13.33）μg/L）were significantly higher in AMI group than those in UA group（（80.00±11.91）,（84.21±13.01）u/mL;（17.19±6.11）,（18.96±6.95）μg/L）,NICP group（（66.18±13.23）,（67.68±13.30）u/mL,（2.97±1.18）,（3.35±1.23）μg/L）and control group（（63.40±8.83）u/mL;（3.22±1.24）μg/L）（P〈0.05）,and in UA group than those in NICP group and control group（P〈0.05）,while there were no significant differences between NICP group and control group（P〉0.05）.There was no significant difference in serum cTnⅠ levels at 3 hafter chest pain attack among AMI group,UA group,NICP group and control group（P〉0.05）.The serum cTnⅠ level was significantly higher in AMI group（（0.436±0.359）μg/L）than that in UA group（（0.041±0.037）μg/L）,NICP group（（0.033±0.029）μg/L）and control group（（0.031±0.018）μg/L）at 6 hafter chest pain attack（P〈0.05）,and there was no significant difference among UA group,NICP group and control group（P〉0.05）.The sensitivities of serum IMA（82.5%,85.9%）and H-FABP（81.3%,83.3%）to ACS,as well as the negative predictive values of IMA（65.8%,72.1%）and H-FABP（69.4%,74.5%）were significantly higher than those of cTnⅠ（sensitivity：10.0%,62.8%;negative predictive value：30.8%,55.4%）at 3 and 6 hafter chest pain attack（P0.05）.The sensitivities of IMA plus H-FABP to ACS（97.5%,98.7%）and the negative predictive values（93.1%,96.9%）were significantly higher than those of the single detection of IMA,H-FABP and cTnⅠ（P0.05）.When the optimal cut-off value of IMA was 77.8 u/mL,the AUCfor ACS was 0.843（95%CI：0.790-0.888）,the sensitivity was 85.4%,and the specificity was 77.9%.The AUC of H-FABP for ACS was 0.920（95%CI：0.884-0.955）,the sensitivity was 81.7%,and the specificity was 100.0%.ConclusionIMA and H-FABP are elevated in the early stage of myocardial injury（3 h）.The detection of IMA and H-FABP contributes to the risk stratification of ACS and exclusion of NICP,and the joint detection of them two could improve the accuracy for ACS.