床旁检测心脏型脂肪酸结合蛋白和肌钙蛋白Ⅰ在急性冠状动脉综合征中的价值

The Value of Bedside Detection of Cardiac Fatty Acid Binding Protein and TroponinⅠin Acute Coronary Syndrome

目的评估床旁检测肌钙蛋白Ⅰ和心脏型脂肪酸结合蛋白在ACS中的临床应用价值。方法选取2017年7月~2018年2月就诊于柳州市人民医院的ACS患者94例为研究对象,根据临床诊断分为AMI组34例、非AMI组60例,并按发病时间将AMI组和非AMI组分别分为0~4 h组和4~12 h组,另选取同期健康体检者40例为对照组,分别统计各组患者的cTnⅠ、HFABP、高敏肌钙蛋白(hs-cTnⅠ)水平和受试者工作特征(ROC)曲线,比较三种标志物对ACS的诊断效能。结果AMI组各发病时段hs-cTnⅠ、床旁快检cTnⅠ、H-FABP水平均高于对照组,差异有统计学意义(P<0.05);非AMI组各发病时段hs-cTnⅠ水平均高于对照组,差异有统计学意义(P<0.05),发病4~12 h,床旁快检cTnⅠ和H-FABP水平高于对照组,差异有统计学意义(P<0.05);非AMI组中,hs-cTnⅠ对于ACS有诊断价值(P<0.05),cTnⅠ、H-FABP和cTnⅠ/H-FABP联合检测无诊断价值(P>0.05);AMI组中,s-cTnⅠ、cTnⅠ、H-FABP、cTnⅠ/H-FABP均有诊断价值(P<0.05)。结论床旁检测cTnⅠ和H-FABP对AMI的诊断效能与hs-cTnⅠ接近,可协助临床科室快速诊断AMI,但对于ACS中非AMI疾病诊断中,床旁检测cTnⅠ/HFABP无法达到hs-cTnⅠ对ACS非AMI疾病的诊断效能,不建议用于协助诊断ACS非AMI疾病。

Objective To evaluate the clinical value of bedside detection of troponinⅠand cardiac fatty acid binding protein in ACS.Methods 94 ACS patients who were admitted to Liuzhou People’s Hospital from July 2017 to February 2018 were selected as the research objects.According to the clinical diagnosis,they were divided into AMI group with 34 cases and non-AMI group with 60 cases.The non-AMI group was divided into 0~4 h group and 4-12 h group.In addition,40 healthy physical examination patients during the same period were selected as the control group,and the cTnⅠ,H-FABP,high-sensitivity troponin(hs-cTnⅠ)levels and receiver operating characteristics(ROC)curves of each group were counted.Compare the diagnostic efficacy of three markers on ACS.Results The levels of hs-cTnⅠ,bedside quick check cTnⅠ,and H-FABP at each onset period of the AMI group were higher than those of the control group,the difference was statistically significant(P<0.05);The level of hs-cTnⅠin the non-AMI group at each onset period was higher than that in the control group,the difference was statistically significant(P<0.05).After 4-12 h of onset,the cTnⅠand H-FABP levels of rapid bedside examination were higher than those of the control group,the difference was statistically significant(P<0.05);In the non-AMI group,hs-cTnⅠhas diagnostic value for ACS(P<0.05),the combined detection of cTnⅠ,H-FABP and cTnⅠ/H-FABP has no diagnostic value(P>0.05);In the AMI group,s-cTnⅠ,cTnⅠ,H-FABP,and cTnⅠ/H-FABP were all of diagnostic value(P<0.05).Conclusion The diagnostic efficacy of cTnⅠand H-FABP at the bedside for AMI is similar to that of hs-cTnⅠ,which can assist clinical departments in the rapid diagnosis of AMI.However,in the diagnosis of non-AMI diseases in ACS,bedside detection of cTnⅠ/H-FABP cannot achieve the diagnostic efficiency of hs-cTnⅠfor ACS non-AMI diseases,and it is not recommended to assist in the diagnosis of ACS non-AMI diseases.