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目的探讨血浆心型脂肪酸结合蛋白(heart-type fatty acid-binding protein,H-FABP)对早期诊断急性心肌梗死(acute myocardial infarction,AMI)的意义。方法发病6h内以急性胸痛就诊的疑似AMI患者83例,根据出院诊断分为AMI组32例与非AMI组51例,非AMI组又分为不稳定型心绞痛33例(UAP组)与非心源性胸痛18例(NCCP组),选择体检健康者40名为对照组,采用ELISA法检测各组血清H-FABP水平,并与传统心肌标志物的诊断效能进行比较。结果 AMI组血清H-FABP水平明显高于非AMI组和对照组(P均<0.01);ROC曲线显示,H-FABP的AUC为0.954(95%CI:0.912～0.997),H-FABP诊断AMI的最佳截断值为6.65ng/mL;H-FABP诊断发病6h内AMI的敏感度、特异度、阴性预测值及准确率分别为90.26%,80.39%,93.18%,84.34%;敏感度、阴性预测值及准确率明显高于传统心肌标志物肌红蛋白、肌酸激酶同工酶和肌钙蛋白I(P<0.05)。结论 H-FABP对发病早期的AMI有较好诊断价值。
Objective To investigate the significance of early detection of acute myocardial infarction (AMI) by heart-type fatty acid-binding protein (H-FABP). Methods Eighty-three patients with suspected AMI who were treated with acute chest pain within 6 hours after onset were divided into 32 AMI patients and 51 non-AMI patients according to discharge diagnosis. Non-AMI patients were divided into unstable angina pectoris (UAP group) and non-AMI patients Eighteen patients (NCCP group) with chest pain were selected and 40 healthy subjects were selected as the control group. Serum H-FABP levels were measured by ELISA and compared with the diagnostic efficacy of traditional myocardial markers. Results The serum level of H-FABP in AMI group was significantly higher than that in non-AMI group and control group (all P <0.01). The ROC curve showed that the AUC of H-FABP was 0.954 (95% CI: 0.912-0.997) The best cut-off value of AMI was 6.65 ng / mL. The sensitivity, specificity, negative predictive value and accuracy of AMI in H-FABP diagnosis were 90.26%, 80.39%, 93.18% and 84.34% The predicted value and accuracy were significantly higher than those of the traditional myocardial markers such as myoglobin, creatine kinase and troponin I (P <0.05). Conclusion H-FABP has a good diagnostic value in the early onset of AMI.