TnI-Ultra、IMA和H-FABP水平在急性冠脉综合征诊断中的临床意义

摘要

目的：探讨心肌缺血生化指标，即超敏肌钙蛋白I（TnI-Ultra）、缺血修饰蛋白（IMA）和心型脂肪酸蛋白（H-FABP）水平在急性冠脉综合征（ACS）诊断中的临床意义。方法收集2013年6月~2015年5月于巴中市中心医院就诊的疑似ACS的患者97例，最终确诊为不稳定型心绞痛28例、ST段抬高型心肌梗死30例、非ST段抬高型心肌梗死22例，非缺血性胸痛17例；所有患者在冠状动脉造影前采集静脉血，用化学发光免疫分析仪检测TnI-Ultra水平，用免疫透射比浊法检测IMA与H-FABP水平，评估ACS患者TnI-Ultra、IMA、H-FABP水平的相关性，比较各组的TnI-Ultra、IMA、H-FABP水平的差异；比较TnI-Ultra、IMA、H-FABP及三指标联合对于ACS的诊断价值。结果所有97例疑似ACS的患者平均年龄（57.34±14.25）岁；其中男性59例，女性38例；最终确诊为ACS80例，其中不稳定型心绞痛28例，男性19例，女性9例，平均年龄（58.24±12.35）岁；ST段抬高型心肌梗死30例、男性18例，女性12例，平均年龄（57.62±13.17）岁；非ST段抬高型心肌梗死22例，男性13例，女性9例，平均年龄（58.08±14.42）岁；非缺血性胸痛17例，男性9例，女性8例，平均年龄（57.85±10.96）岁。不稳定型心绞痛组、ST段抬高型心肌梗死组、非ST段抬高型心肌梗死组以及非缺血性胸痛组的年龄、性别、合并疾病、服药史的差异均无统计学意义（P＞0.05），ACS三组患者的TnI-Ultra、IMA、H-FABP水平均高于非缺血性胸痛组（P＜0.05）。ACS患者TnI-Ultra、IMA、H-FABP水平的相关性分析结果显示：TnI-Ultra与IMA呈正相关（r＝0.340，P＝0.001）；TnI-Ultra与H-FABP呈正相关（r＝0.442，P＜0.001）；IMA与H-FABP呈正相关（r＝0.322，P＝0.001）。三指标联合诊断ACS的灵敏度93.75％、假阴性率6.25%，特异度100%、假阳性率0%，阳性预测值100%，阴性预测值77.27%，准确率94.85%；三指标联合的灵敏度、阴性预测值、准确率均显著高于各指标单独对于ACS的诊断价值（P＜0.05）。结论 TnI-Ultra、IMA和H-FABP水平联合诊断ACS有一定的临床意义。%Objective To investigate the clinical significance of levels of myocardial ischemic biochemical indexes including troponin I-Ultra (TnI-Ultra), ischemia modified albumin (IMA) and heart-type fatty acid-binding protein (H-FABP) in diagnosis of acute coronary syndrome (ACS).Methods The patients with suspected ACS (n=97) were chosen from the Central Hospital of Bazhong City from Jun. 2013 to May 2015, and finally 28 were diagnosed with unstable angina pectoris (UAP group), 30 with ST-segment elevation myocardial infarction (STEMI group), 22 with non-ST-segment elevation myocardial infarction (non-STEMI group) and 17 with non-ischemia chest pain (non-ischemia chest pain group). The venous blood samples were collected from all patients before coronary angiography (CAG). The level of TnI-Ultra was detected by using electro-chemiluminescence immunoassay (ECLIA), and levels of IMA and H-FABP were detected by using immune transmission turbidity method. The correlation among TnI-Ultra, IMA and H-FABP was reviewed in ACS patients and difference in levels of TnI-Ultra, IMA and H-FABP was compared in all groups. The values of TnI-Ultra, IMA and H-FABP and TnI-Ultra+IMA+H-FABP to the diagnosis of ACS were compared.Results All 97 patients with suspected ACS averagely aged (57.34±14.25), and among them 59 were male and 38, female. There were 80 patients diagnosed definitely with ACS, 28 with UAP (male 19, female 9, average age=58.24±12.35), 30 with STEMI (male 18, female 12 and average age=57.62±13.17), 22 with non-STEMI (male 13, female 9 and average age=58.08±14.42), and 17 with non-ischemia chest pain (male 9, female 8 and average age=57.85±10.96). The difference in age, sex, complicating diseases and medication history had no statistical significance among all groups (P>0.05). The levels of TnI-Ultra, IMA and H-FABP were higher in UAP group, STEMI group and non-STEMI group than those in non-ischemia chest pain group (P<0.05). The results of correlation analysis on TnI-Ultra, IMA and H-FABP showed that TnI-Ultra was positively correlated to IMA (r=0.340,P=0.001), TnI-Ultra was positively correlated to H-FABP (r=0.442,P<0.001), and IMA was positively correlated to H-FABP (r=0.322,P=0.001). The sensitivity of TnI-Ultra+IMA+ H-FABP in diagnosis of ACS was 93.75%, false negative rate was 6.25%, specificity was 100%, false positive rate was 0%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 77.27%, and rate of accurateness was 94.85%. The sensitivity, PPV and rate of accurateness of TnI-Ultra+IMA+H-FABP were all higher significantly than those of single index in diagnosis of ACS (P<0.05).Conclusion The levels of TnI-Ultra, IMA and H-FABP have clinical significance in combined diagnosis of ACS.