血游离脂肪酸在急性心肌梗死中的诊断价值

Diagnosis Value of Serum Free Fatty Acids in Acute Myocardial Infarction

目的探讨血游离脂肪酸(FFAs)在急性心肌梗死(AMI)患者临床诊断中的应用价值。方法采用观察性研究方法,共入选2017年1月至2018年12月郑州大学第一附属医院心内科住院患者295例,根据患者诊断结果分为AMI组(94例)、亚急性心肌梗死(Sub-AMI)组(54例)、陈旧性心肌梗死(OMI)组(30例)、非梗死型冠心病(CAD)组(49例)和正常对照组(68例)。比较各组患者血FFAs、TnⅠ、CK-MB等指标水平,分析FFAs与TnⅠ、CK-MB的相关性,采用ROC曲线评估FFAs对AMI的诊断价值。结果AMI组患者血清FFAs水平[(0.93±0.42)mmol·L^-1]高于其他各组,差异有统计学意义(均P<0.05);FFAs与心肌损伤标志物TnⅠ及CK-MB呈显著正相关关系(r=0.566、0.532,P<0.001),FFAs诊断AMI的ROC曲线下面积为0.842(95%CI:0.795~0.888,P<0.001),最佳截断值为0.615 mmol·L^-1,其灵敏度为79.6%,特异度为77.2%。结论AMI患者血FFAs水平显著升高,血FFAs诊断AMI敏感性和特异性均较好,有望成为AMI发生后常规进行检测的生物标志物之一。

Objective To evaluate the diagnosis value of serum free fatty acids(FFAs)for patients with acute myocardial infarction(AMI).Methods A observational study was conducted,and a total of 295 eligible patients from the First Affiliated Hospital of Zhengzhou University were enrolled during January 2017 to December 2018.According to their diagnoses,these patients were classified into five groups,AMI(94 cases),sub-acute myocardial infarction(sub-AMI,54 cases),old myocardial infarction(OMI,30 cases),coronary artery disease(CAD)but without any myocardial infarction(49 cases)and normal control group(68 cases).The levels of serum FFAs,TNⅠand CK-MB were compared among groups,the correlations between FFAs and TnⅠor CK-MB were analyzed,and the diagnosis value of FFAs for AMI was evaluated by ROC curve.Results Serum FFAs level in the AMI group[(0.93±0.42)mmol·L^-1]was higher than other groups,and the differences were all statistically significant(all P<0.05).The correlations between serum FFAs and serum TNI or CK-MB were both positive in these patients with AMI(r=0.566,0.532,P<0.001),and the ROC curve analysis indicated that the highest area under the curve was 0.842(95%CI:0.795-0.888,P<0.001),the optimal cut-off value was 0.615 mmol·L^-1(sensitivity 79.6%and specificity 77.2%).Conclusion Serum FFAs level was significantly increased in patients with AMI,and had good sensitivity and specificity in the diagnosis of AMI,so serum FFAs has the potentiality to become a routine examination biomarker after AMI.