心脏型脂肪酸结合蛋白在急诊胸痛患者中的诊断价值

Diagnostic value of heart-type fatty acid-binding protein in patients with acute chest pain

关键词:  心脏型脂肪酸结合蛋白  急性心肌梗死  肌钙蛋白I  超敏C-反应蛋白

Key words:  heart-type fatty acid-binding protein  acute myocardial infarction  cardiac troponin I  high sensitive C-reactive protein

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0～6 h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cTnI、CK-MB、hs-CRP联合检测更能提高诊断效率。

Abstract:

［Objective］To investigate the value of heart-type fatty acid binding protein (H-FABP) in patients with acute 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 troponin 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.