H-FABP和IMA联合检测对急性心肌梗死患者早期诊断的价值

摘要

目的 探讨心型脂肪酸结合蛋白(H-FABP)、缺血性修饰白蛋白(IMA)诊断急性心肌梗死(AMI)患者的临床价值.方法 随机选取2015年6月至2016年10月的AMI(132例)、非缺血性胸痛(NICP)(60例)和健康体检者(60例),检测并比较AMI和 NICP患者各时段(按距急性胸痛发作时间采血为0~3、4~7、8~15h共3个时间段)血清中H-FABP、IMA、肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)水平,计算各项指标阳性率、灵敏度、特异度,绘制ROC曲线,分析其对AMI患者的诊断价值.结果 AMI患者H-FABP、IMA、cTnI、CK-MB均值、阳性率均高于同时间段 NICP和健康对照者(P均<0.05或<0.01).AMI组在7h内H-FABP 的灵敏度最高,IMA其次,两者均优于CK-MB和cTnI(P均<0.05),H-FABP联合IMA的灵敏度优于单独检测IMA或H-FABP(P<0.05);各时间段特异度cTnI最高,IMA、H-FABP其次;经ROC曲线分析可知,各指标曲线下面积(AUC):H-FABP+IMA=四项指标联合>H-FABP> CK-MB> cTnI> IMA.与单一指标比较,H-FABP联合IMA检测对AMI的临床诊断价值较高(P<0.05).结论 H-FABP与 IMA两项联合检测可提高AMI的早期诊断效率.%Objective To investigate the clinical value of heart fatty acid binding protein (H-FABP)and ischemic modified protein (IMA)in patients with acute myocardial infarction(AMI). Methods AMI (132 cases), non-ischemic chest pain (NICP)(60 cases)and physical examination (60 cases)were randomly selected from June 2015 to October 2016. The serum levels of H-FABP, IMA,cardiac troponin(cTnI),creatine kinase isoenzyme (CK-MB)in serum were detected and compared between AMI and NICP patients at different time points (blood sampling from 0 to 3,4 to 7 and 8 to 15 hours from the onset of acute chest pain). The positive rate, sensitivity and specificity of each index were calculated, and ROC curve was drawn to analyze the diagnostic value of IMA and H-FABP,cTnI,CK-MB in AMI patients. Results The mean and positive rates of H-FABP, IMA,cTnI and CK-MB in AMI patients were significantly higher than those in NICP and healthy controls (all P<0.05 or <0.01). The sensitivity of H-FABP in AMI group was highest in 7 hours,IMA was the second,both were better than CK-MB and cTnI (all P<0.05). The sensitivity of H-FABP combined with IMA was better than IMA or H-FABP alone(P<0.05). The specificity cTnI was the highest and IMA,H-FABP were the second in each time period.By ROC curve analysis the area under the curve of each index(AUC)was: H-FABP + IMA =four indicators combined> H-FABP> CK-MB> cTnI> IMA. Compared with a single index, H-FABP combined withIMA detection was of higher value in the clinical diagnosis of AMI (P<0.05). Conclusion Only H-FABPcombined with IMA can significantly improve the early diagnosis of AMI.