心肌型脂肪酸结合蛋白在钝性心脏损伤早期诊断中的价值  

The value of heart-type fatty acid-binding protein for early diagnosis of blunt cartiac injury

作　　者：郎宇璜[1] 缪京丰[1] 向明[2] 刘辉[2] 

机构地区：[1]复旦大学附属上海市第五人民医院急诊科,上海200240 [2]复旦大学附属上海市第五人民医院胸外科,上海200240

出　　处：《中华急诊医学杂志》2009年第4期415-419,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨心肌型脂肪酸结合蛋白（heart-type fatty acid-binding protein，H-FABP）在钝性心脏损伤（blunt cardiac injury，BCI）早期诊断中的价值。方法前瞻性研究2007年1月至2008年6月间复旦大学附属上海市第五人民医院收治的42例钝性胸部损伤患者和同期本院健康体检中心42例健康体检者血清心肌标志物水平，采用双抗体夹心酶联免疫一步法定量检测42例健康体检者和42例钝性胸部损伤患者伤后3，6，12h血清H-FABP、心肌肌钙蛋白Ⅰ（cardiac troponinⅠ，cTnⅠ）和肌红蛋白（Myoglobin，Myo）含量。以cTnⅠ作为诊断BCI的金标准，将42例钝性胸部损伤患者分为心肌损伤组（13例）和非心肌损伤组（29例）。绘制H—FABP和cTnⅠ在胸部损伤患者伤后3，6，12h诊断BCI的受试者特征曲线（receiver operating characteristic curve，ROCcurve），并比较曲线下面积area under the curve，AUC），分析伤后不同时间（3，6，12h）血清H-FABP和cTnⅠ对BCI的诊断价值。多组均数间的差异性比较采用Kruskal Wallis检验，ROC曲线下面积比较采用delong．clarke-pearson检验。以P〈0．05为差异具有统计学意义。结果伤后3h诊断BCI的AUCB-FABp和AUCcTnⅠ分别为0．9257和0．6844。AUC H-FABP大于AUCcTnⅠ，二者差异具有统计学意义（P=0．0125），伤后12h诊断BCI的AUCH-FABP小于AUCcTnⅠ，差异具有统计学意义（0．9841VS．0．8276，P=0．0278），二者对诊断伤后6hBCI的ROC曲线下面积相比，差异无统计学意义（0．9655vs．0．9125，P=0．2609）。结论H-FABP对BCI具有早期诊断价值，其伤后3h的敏感性优于cTnⅠ。Objective To study the value of heart-type fatty acid-binding protein （H-FABP） for the early diagnosis of blunt cardiac injury（BCI）. Method A prospective study was carried out in 42 patients, who suffered from blunt thoracic injury and were admitted from January 2007 to June 2008, and another 42 healthy individuals in the health center of the Shanghai Fifth Hospital were recruited as control. Serum H-FABP, cTn Ⅰ and Myo levels of both healthy individuals and patients at 3,6 and 12 hours after trauma were measured by using ELISA. Serum cTn Ⅰ levels was taken as a golden standard for the diagnosis of BCI. Accroding to serum cTn Ⅰ levels, 42 patients with blunt thoracic injury were divided into group of patients with myocardial damage （ 13 patients） and group of patients without （29 patients） .The receiver operating characteristic curves （ROC） of H-FABP and cTn Ⅰ in the diagnosis of BCI drawed at 3,6 and 12 hours after trauma, respectively,and the areas under curve （AUC） of ROC were compared, The values of H-FABP and cTnⅠ for diagnosing at 3,6 and 12 hours after trauma were analyzed. Differences in serum H-FABP, cTn Ⅰ and Myo concentrations between groups were compared by Kruskal Wallis test. The delong, clarkepearson test was used to compare the areas under the ROC curves. Results AUCH-FARP and AUCcTnⅠ for diagnosing BCI at 3 hours after trauma were 0.9257 and 0.6844, respectively, and AUCrABp was significantly more than AUCcTnⅠ （P = 0.0125）. AUCB-FABP was signiticanfly less than AUCcTnⅠ （0.9841 vs. 0.8276, P = 0.0278） for diagnosing BCI at 12 hours after trauma.There was no significant difference in diagnosing BCI between AUCB-FABP and AUCcTnⅠ at 12 hours after trauma （0.9655 vs. 0.9125, P = 0.2609）. Conclusions H-FABP is valuabe in the early diagnosis of BCI, and its sensitivity is higher than that of cTn Ⅰ in diagnosing BCI at 3 hours after trauma.

关 键 词：心肌型脂肪酸结合蛋白 钝性心脏损伤 心肌肌钙蛋白-Ⅰ 12导联心电图 

分 类 号：R542.22[医药卫生—心血管疾病] R587.104[医药卫生—内科学]