【摘要】 目的探讨血清心型脂肪酸结合蛋白(H-FABP)在急性心肌梗死(AMI)早期诊断中的临床应用价值。方法随机选择110例临床疑似AMI胸痛患者,采用时间分辨免疫荧光测定法(TRIFA)检测患者入院即刻血清中H-FABP含量,并与心肌肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hsCRP)和肌红蛋白(MYO)进行比较;对11例患者入院即刻和入院6 h后进行动态分析;以60例体检健康者作对照,绘制各心肌损伤标志物受试者工作特征(ROC)曲线并进行曲线下面积(AUC)比较,分析6种心肌损伤标志物诊断早期AMI的敏感度和特异度。结果 AMI患者入院即刻各心肌损伤标志物的AUC由大到小依次为H-FABP、hsCRP、cTnI、CK-MB、CK和MYO,最佳临界值诊断灵敏度分别为85.0%、78.7%、81.3%、73.8%、72.5%和61.3%,特异度分别为93.3%、95.0%、93.3%、100.0%、100.0%、98.3%。H-FABP的AUC与hsCRP、cTnI比较差异无统计学意义(P>0.05),与CK-MB、CK、MYO比较差异有统计学意义(P<0.05)。H-FABP诊断早期AMI的阳性率达85.0%。结论 H-FABP对于AMI早期诊断具有相对较早的检测窗口期和相对较好的特异度,在时效性、灵敏度和特异度等方面具有综合优势,可作为AMI早期诊断或排除诊断的血清标志物。多项心肌损伤指标联合检测可提高AMI实验室诊断的灵敏度、特异度及准确性。更多还原

【Abstract】 Objective To explore the significance of heart-type fatty acid-binding protein(H-FABP) for the diagnosis of acute myocardial infarction(AMI).Methods The serum levels of cardiac troponin I(cTnI),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),hypersensitive C-reaction protein(hsCRP) and myoglobin(MYO) in 110 cases of patients with thoracalgia were detected when being hospitalized,among which 11 cases were detected for the mentioned indexes both at being hospitalized and 6 hours later.60 cases of healthy individuals were enrolled as control group.The diagnostic sensitivity and specificity of the six indexes were analyzed by receiver operating characteristic curve.Results The area under curve(AUC),ranged from high to low,were H-FABP,hsCRP,cTnI,CK-MB,CK and MYO,with the diagnostic sensitivity of 85.0%,78.7%,81.3%,73.8%,72.5% and 61.3%,the specificity of 93.3%,95.0%,93.3%,100.0%,100.0% and 98.3%.There was no statistical difference of the AUC between hsCRP and cTnI and H-FABP(P>0.05),but there was statistical difference of AUC between CK-MB,CK and MYO and H-FABP(P<0.05).Conclusion H-FABP could be used for the early diagnosis of AMI,with high specificity and sensitivity.Combined detection of different indexes could improve the diagnostic sensitivity,specificity and accuracy for AMI.更多还原