文章摘要
梁晓芳,崔建国,李春坚,杨志健,马文珠,曹克将.心脏型脂肪酸结合蛋白快速诊断试纸在急性心肌梗死患者中的应用研究[J].南京医科大学学报,2009,29(8):1133~
心脏型脂肪酸结合蛋白快速诊断试纸在急性心肌梗死患者中的应用研究
The diagnostic efficacy of the rapid heart-fatty acid-binding protein test in patients with early acute myocardial infarction
投稿时间:2009-02-06  
DOI:10.7655
中文关键词: 心脏型脂肪酸结合蛋白(H-FABP)  急性心肌梗死(AMI)  肌钙蛋白T  肌酸激酶同工酶  肌红蛋白
英文关键词: heart-type fatty-acid binding protein  acute myocardial infarction  TroponinT  creatine kinase-myocardial band  myoglobin
基金项目:霍英东教育基金会第十届高等院校青年教师基金(优选资助课题)资助项目(104037)
作者单位
梁晓芳 南京医科大学第一附属医院心脏科,江苏 南京 210029 
崔建国  
李春坚  
杨志健  
马文珠  
曹克将  
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中文摘要:
      目的:探讨心脏型脂肪酸结合蛋白(H-FABP)在早期诊断急性心肌梗死(AMI)方面的价值?方法:连续检测发病6 h内入院的胸痛患者104例,所有病例均于入院即刻采用H-FABP快速诊断试纸进行定性检测,同时测定患者血清心肌肌钙蛋白T(cTnT)?肌酸激酶同工酶(CK-MB)?肌红蛋白(MYO)水平,比较上述4种心肌损伤标志物在诊断AMI方面的敏感性和特异性?结果:入选患者中最终确诊AMI者51例,非心肌梗死者53例,其中不稳定型心绞痛(UAP)17例,稳定型心绞痛(SAP)16例,非心源性胸痛者(NCCP)20例?参照标准诊断,H-FABP?MYO?CK-MB和cTnT检出AMI的敏感性分别为86.27%,68.63%,47.06%和47.06%,H-FABP显著高于后3者(P均< 0.05);检测特异性分别为84.90%,84.90%,96.23%和98.11%,H-FABP的特异性较cTnT差(P < 0.05),而与MYO?CK-MB无显著差异?对于胸痛发生3 h内的患者,H-FABP?MYO?CK-MB和cTnT诊断AMI的敏感性依次为79.17%,58.33%,37.50%和33.33%;对于胸痛发生3~6 h的患者,相应的检出敏感性分别为92.59%,77.78%,55.56%和59.26%;在上述2种时间段HFABP的敏感性均显著高于CK-MB和cTnT(P均< 0.05)?在胸痛6 h内,H-FABP联合cTnT检出AMI的敏感性为92.16%,显著高于MYO?CK-MB和cTnT三者联合检测的敏感性76.47%,(P < 0.05),而2种组合的检测特异性无显著差异?结论:H-FABP快速定性检测试剂盒使用简便快捷,在AMI早期(发病≤6 h)具有更高的诊断价值;H-FABP与cTnT联合用于AMI的诊断可进一步提高检测敏感性,且保持较高的特异性,优于传统的MYO?CK-MB与cTnT 3项组合?
英文摘要:
      Objective: To evaluate the efficacy of heart-type fatty-acid binding protein (H-FABP) for early diagnosis of AMI. Methods:One hundred and four consecutive patients admitted to the hospital within 6 h after the onset of chest pain were recruited in the study. A rapid test kit for qualitative determination of H-FABP was applied to detect the whole serum H-FABP level in all patients at the time of admission. Serum troponinT (cTnT), creatine kinase-myocardial band(CK-MB), and myoglobin(MYO) were also measured simultaneously. Results:Among 104 recruited patients, 51 had a final diagnosis of AMI,and 53 were excluded from AMI, among whom 17 were diagnosed as UAP, 16 as SAP, and 20 as non-cardiogenic chest pain. By comparing the results of the biochemical tests with the standard diagnosis,the sensitivity of H-FABP,MYO,CK-MB and cTnT in diagnosis of AMI were 86.27%, 68.63%, 47.06% and 47.06% respectively. The sensitivity of H-FABP was significantly higher than that of MYO, CK-MB and cTnT (P < 0.05 for all). In terms of specificity, the numbers are 84.90%, 84.90%, 96.23% and 98.11% respectively. The specificity of H-FABP was lower than that of cTnT(P < 0.05), but there was no significant difference between H-FABP and MYO or CK-MB; Within 3 hours after the onset of symptome appearance, the respective sensitivity of H-FABP,MYO,CK-MB and cTnT in diagnosis of AMI was 79.17% ,58.33%, 37.50% and 33.33%;Within 3~6 hours, the respective sensitivity was 92.59%,77.78%,55.56% and 59.26%. In both of the two time stage , the sensitiviy of H-FABP were significantly higher than that of CK-MB and cTnT(both P < 0.05); Within 6 hours after the onset of chest pain, the sensitivity of H-FABP + cTnT was significantly higher than that of MYO+CK-MB + cTnT (92.16% vs 76.47%, P < 0.05), but the differences between the specificity of the two were not statistically significant. Conclusion: The rapid qualitative H-FABP test kit has high efficacy in the diagnosis of AMI as early as within 6 hours of symptom onset. Combining H-FABP and cTnT provides higher sensitivity than the MYO,CK-MB and cTnT combination in the diagnosis of early AMI.
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