心型脂肪酸结合蛋白联合高敏肌钙蛋白I在急性心肌梗死快速分诊中的应用价值

Application value of heart fatty acid binding protein combined with high-sensitivity cardiac troponin I in rapid diagnosis of acute myocardial infarction

目的 探讨心型脂肪酸结合蛋白(H-FABP)联合高敏肌钙蛋白I(hs-cTnI)在急性心肌梗死(AMI)快速分诊中的应用价值。方法 选取浙江省湖州市第一人民医院2021年3月至2022年月3月收治的105例以胸痛为首发症状的疑似AMI患者和200名正常参考人群。测定患者入院即刻(0 h)及入院1 h的血清H-FABP、hs-cTnI水平,确定H-FABP、hs-cTnI的截断值,制订H-FABP联合hs-cTnI快速分诊策略,分析H-FABP联合hs-cTnI快速分诊法对AMI的诊断效能。结果 血清H-FABP、hs-cTnI的截断值分别为6.30 ng/ml、10.65 pg/ml。疑似AMI患者入院0、1 h的血清H-FABP及hs-cTnI水平均高于正常参考人群,差异有统计学意义(P<0.05)。疑似AMI患者入院1 h的血清H-FABP、hs-cTnI水平均高于入院0 h,差异有统计学意义(P<0.05)。根据H-FABP联合hs-cTnI快速分诊流程,45例(42.86%)纳入AMI排除组,50例(47.62%)纳入AMI入选组,10例(9.52%)纳入留观组。快速分诊对AMI的诊断灵敏度为100.00%、特异度为88.71%、阳性预测值为86.00%、阴性预测值为100.00%。入院1 h H-FABP+hs-cTnI诊断AMI的曲线下面积均高于入院0 h,差异有统计学意义(P<0.05)。结论 入院0、1 h的血清H-FABP及hs-cTnI水平变化可快速诊断或排除大部分AMI,这对于实现AMI的快速分诊,降低患者死亡率及误诊率有积极意义。

Objective To explore the value of heart fatty acid binding protein(H-FABP)combined with high-sensitivity cardiac troponin I(hs-cTnI)in rapid diagnosis of acute myocardial infarction.Methods A total of 105 suspected AMI patients with chest pain as the first symptom and 200 normal reference population admitted to the First People’s Hospital of Huzhou,Zhejiang Province from March 2021 to March 2022 were selected.Serum H-FABP and hs-cTnI levels were measured immediately after admission(0 h)and 1 h after admission,and the cut-off values of H-FABP and hs-cTnI were determined.The rapid triage strategy of H-FABP combined with hs-cTnI was formulated and the diagnostic efficacy of H-FABP combined with hs-cTnI for AMI was analyzed.Results The cut-off values of serum H-FABP and hs-cTnI were 6.30 ng/ml and 10.65 pg/ml,respectively.Serum H-FABP and hs-cTnI levels in patients with suspected AMI at 0 h and 1 h after admission were higher than those in normal reference population,and the differences were statistically significant(P<0.05).Serum H-FABP and hs-cTnI levels of patients with suspected AMI 1 h after admission were higher than those of 0 h after admission,and the differences were statistically significant(P<0.05).According to the H-FABP combined hs-cTnI rapid triage process,45 cases(42.86%)were included in the AMI exclusion group,50 cases(47.62%)in the AMI inclusion group,and 10 cases(9.52%)in the observation group.The sensitivity,specificity,positive predictive value,and negative predictive value of rapid triage for AMI were 100.00%,88.71%,86.00%,and 100.00%respectively.The area under the curve of H-FABP+hs-cTnI in the diagnosis of AMI 1 h after admission were higher than those 0 h after admission,and the differences were statistically significant(P<0.05).Conclusion The changes of serum H-FABP and hs-cTnI levels at 0 h and 1 h after admission can rapidly diagnose or exclude most AMI,which has positive significance for realizing rapid triage of AMI and reducing the mortality and misdiagnosis rate of patients.