心脏型脂肪酸结合蛋白在急诊胸痛患者中的诊断价值

摘要

[目的]探讨心脏型脂肪酸结合蛋白(H - FABP)在急诊胸痛患者中的诊断价值.[方法]筛选急诊胸痛患者128例(0～6 h),立即采用H- FABP快速诊断试纸进行定性检测,同时测定血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs - CRP)水平,计算各项指标单独及联合检测在诊断急性心肌梗死(AMI)方面的灵敏度和特异度.[结果]入选患者最终确诊AMI者68例,在0～6h内H- FABP、cTnI、CK - MB、hs - CRP检出AMI的灵敏度分别为88.23％、44.12％、41.18％、42.65％；特异度分别为83.33％、93.30％、86.67％、86.70％,在灵敏度方面H - FABP与其它指标比较差异有显著性意义(P＜0.05)；但在特异度上H- FABP与其它指标比较差异无显著性意义(P＞0.05).各项指标联合检测的灵敏度为92.64％、特异度为91.60％,阳性预测值及阴性预测值分别为98.00％、90.00％.[结论]H- FABP是筛查急诊胸痛患者是否发生急性心肌梗死的中最灵敏的指标,具有重要的临床诊断价值；与cTnl、CK - MB、hs - CRP联合检测更能提高诊断效率.%[ Objective] To investigate the value of heart - type fatty acid binding protein (H - FABP) in patients with a-cute chest pain. [ Methods ] One hundred and twenty - eight patients within six hours after the onset of chest pain were selected. A qualitative detection of H - FABP was performed instantly using rapid test kit, The plasma levels of cardiac tropo-nin I (cTnI) ,creatine kinase isoenzyme - MB (CK - MB) and high sensitive C - reactive protein (hs - CRP) were detected simultaneously. The sensitivity and specificity in diagnosis of acute myocardial infarction (AMI) were calculated. [ Results] Among 128 selected patients, 68 had a final diagnosis of AMI. The sensitivities of H - FABP, cTnI, CK - MB and hs - CRP in diagnosis of AMI were 88.23% ,44.12% , 41. 18% and 42. 65% respectively within six hours,and the sensitivity of H - FABP was significantly higher than that of others (P ＜ 0.05). The specificities of H - FABP, cTnI, CK - MB and hs - CRP were 83. 33% , 93.30% , 86. 67% and 86. 70% respectively. The specificity of H - FABP compared with others that was not statistically significant (P ＞ 0.05) within 6 hours. The sensitivity (92.64% ), specificity (91.60% ), positive value (98.00% ) and negative value (90. 00% ) of combined H - FABP, cTnI , CK - MB and hs - CRP were the highest within 0-6 hours. [ Conclusion ] Heart - type fatty acid binding protein is the most sensitive indicator for early AMI (within 6 hours) diagnosis and has very important application value for clinical diagnosis. The combination determination of multiple - index can improve efficiency of AMI diagnosis.