床旁快速检测心肌标志物在急性心肌梗死诊断及预后中的应用价值

Application value of bedside rapid detection of myocardial markers in diagnosis and prognosis of acute myocardial infarction

目的探讨床旁快速检测心肌标志物在急性心肌梗死诊断及预后中的应用价值。方法选取2018年1月至2018年12月本院急诊科收治的200例急性心肌梗死患者为研究对象,按照发病时间分为<3 h组(n=80)与3~6 h组(n=120),按照诊断结果分为ST段抬高心肌梗死(STEMI)组(n=115)与非ST段抬高心肌梗死(NSTEMI)组(n=85)。对所有患者的心肌型脂肪酸结合蛋白(H-FABP)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、肌红蛋白(MYO)及D-二聚体(D-Dimer)水平进行床旁快速检测,分析各项心肌标志物对急性心肌梗死的诊断价值及对预后的预测价值。结果 3~6 h组患者H-FABP、MYO水平均明显高于<3 h组(P<0.05),两组CK-MB、cTnI及D-Dimer水平比较差异均无统计学意义。NSTEMI组患者H-FABP、MYO、CK-MB及cTnI水平均明显高于STEMI组(P<0.05),两组D-Dimer水平比较差异无统计学意义。H-FABP的敏感度、特异度及AUC分别为0.954、0.910、0.948,MYO的敏感度、特异度及AUC分别为0.959、0.775、0.890,H-FABP的诊断效能明显优于其他心肌标志物(P<0.05),H-FABP的特异度明显高于MYO(P<0.05)。H-FABP与MYO对急性心肌梗死患者预后的预测能力明显优于CK-MB、cTnI及D-Dimer(P<0.05)。结论床旁快速检测H-FABP对急性心肌梗死具有较高的诊断价值,H-FABP与MYO水平升高表示急性心肌梗死患者的预后不良。

Objective To discuss the application value of bedside rapid detection of myocardial markers in diagnosis and prognosis of acute myocardial infarction.Methods A total of 200 patients with acute myocardial infarction who were selected as the study subjects in the emergency department of our hospital from January 2018 to December 2018.According to the onset time,the patients were divided into the <3 h group(n=80) and the 3-6 h group(n=120).According to the diagnosis,they were divided into the ST-segment elevation myocardial infarction(STEMI) group(n=115)and the non-ST-segment elevation myocardial infarction(NSTEMI) group(n=85).The levels of heart-type fatty acid-binding protein(H-FABP),creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),myohemoglobin(M、O) and D-Dimer were rapidly detected by bedside monitoring.The diagnostic value and prognostic value of myocardial markers for acute myocardial infarction were analyzed.Results The levels of H-FABP and MYO in the 3-6 h group were significantly higher than those in the <3 h group(P<0.05),and there was no significant difference in levels of CKMB,cTnI and D-Dimer between the two groups.The levels of H-FABP,MYO,CK-MB and cTnI in the NSTEMI group were significantly higher than tho se in the STEMI group(P<0.05),and there was no significant difference in levels of D-Dimer between the two groups.The sensitivity,specificity and AUC of H-FABP were 0.954,0.910 and 0.948 respectively,while the sensitivity,specificity and AUC of MYO were 0.959,0.775 and0.890 respectively.The diagnostic efficacy of H-FABP was obviously superior to other cardiac markers(P<0.05).The specificity of H-FABP was significantly higher than that of MYO(P<0.05).The progno stic ability of H-FABP and MYO in patients with acute myocardial infarction was significantly better than that of CK-MB,cTnl and D-Dimer(P<0.05).Conclusion Bedside rapid detection of H-FABP had high diagnostic value for acute myocardial infarction,and elevated H-FABP and MYO levels indicate poor progno sis in patients with acute myocardial infarction.