心型脂肪酸结合蛋白在诊断急性心肌梗死中的临床意义  

The clinical significance of heart type fatty acid-binding protein in diagnosis of acute myocardial infarction

作　　者：丁柳美[1] 唐钧[1] 倪培华[2] 

机构地区：[1]复旦大学附属金山医院检验科,上海200540 [2]上海交通大学医学院附属瑞金医院检验系,上海200025

出　　处：《检验医学》2011年第6期383-386,共4页Laboratory Medicine

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)诊断中的价值。方法采用双抗体夹心酶联免疫法测定78例AMI、52例不稳定性心绞痛(UA)、65例稳定性心绞痛(SA)患者及70名健康对照者血清H-FABP水平,同时测定心肌肌钙蛋白I(cTnI)、肌酸激酶质量(CK-MB mass)并作比较。测定32例发病至采血间隔2 h以内以及46例间隔2 h以上的AMI患者的H-FABP水平,并与cTnI比较,分析其诊断价值。结果 AMI组H-FABP、CK-MB mass、cTnI浓度分别为(78.12±23.78)μg/L、(9.48±2.68)μg/L、(10.12±3.45)ng/mL,明显高于UA组[(18.67±7.45)μg/L、(0.56±0.11)μg/L、(0.21±0.12)ng/mL]、SA组[(2.98±1.65)μg/L、(0.22±0.08)μg/L、(0.08±0.06)ng/mL]和对照组[(2.32±1.12)μg/L、(0.20±0.09)μg/L、<0.022 ng/mL](P<0.05);UA组H-FABP、CK-MB mass、cTnI浓度明显高于SA组和对照组(P<0.05);而SA组和对照组之间H-FABP、CK-MB mass、cTnI浓度均无差异(P>0.05)。H-FABP灵敏度为84.89%、特异性为98.8%、准确率为85.89%、阳性预测值为93.24%、阴性预测值为75.14%,均高于CK-MB mass(50.11%、89.12%、78.54%、80.12%、50.78%)和cTnI(60.22%、93.23%、80.34%、86.45%、60.56%)。在发病2 h内采血的32例AMI患者中,H-FABP阳性率(65.63%)明显高于cTnI阳性率(18.75%)(P<0.05);在发病2 h以后采血的46例AMI患者中,H-FABP阳性率(97.83%)与cTnI阳性率(89.13%)比较差异无统计学意义(P>0.05)。结论 H-FABP在诊断AMI具有较高的灵敏度和特异性,可作为AMI的标志物,具有临床应用价值。Objective To study the diagnostic significance of heart type fatty acid-binding protein （H-FABP） in acute myocardial infarction （ AMI ）. Methods H-FABP, cardiac troponin I （cTnI） and creatine kinase （CK） -MB mass were detected in 78 patients with AMI, 52 patients with unstable angina（UA） ,65 patients with stable angina（SA） and 70 healthy controls by double antibody sandwich enzyme-linked immunosorbent assay. 32 blood samples were collected within 2 h after AMI occurrence, and 46 blood samples were collected after AMI occurrence more than 2 h. Their H-FABP levels were detected and compared with cTnI. The diagnostic significance was analyzed. Results The levels of H-FABP, CK- MB mass and cTnI of AMI group [ （78. 12 ± 23.78） μg/L, （9.48 ± 2.68） μg/L and（ 10. 12 ± 3.45） ng/mL] were significantly higher than those of UA group [ （ 18.67 ± 7.45 ） μg,/L, （0.56 ± 0.11 ） μg,/L and （ 0.21 ± 0.12） ng/mL ], SA group [ （ 2.98 ± 1.65 ） μg,/L, （0.22 ± 0.08 ） μg/L and （ 0.08 ± 0.06 ） ng/mL] and control group [ （ 2.32 ± 1.12 ） μ/L, （0.20 ± 0.09） μg/L and 〈 0. 022 ng/mL] （ P 〈 0.05 ）. H-FABP, CK-MB mass and eTnI of UA group were significantly higher than those of SA group and control group （ P 〈 0.05 ）. The H-FABP, CK-MB mass and cTnI levels had no difference between SA group and control group （P 〉 0.05 ）. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of H-FABP in AMI diagnosis were 84.89% ,98.8% ,85.89% ,93.24% and 75.14% ,which were higher than CK-MB mass （50.11% ,89.12% ,78.54% ,80. 12% and 50. 78% ） and cTnI（60.22% ,93.23% ,80.34%, 86.45% and 60.56% ） respectively. In the 32 cases＇ blood collected within 2 h, the positive rate of H-FABP （65.63%） was higher than that of cTnI （ 18.75% ） （ P 〈 0.05 ）. In the 46 cases＇ blood collected after more than 2h, the positive rate of H-FABP （97.83%） had no statistical difference with that of cTnI （ 89.13%

关 键 词：心型脂肪酸结合蛋白 心肌肌钙蛋白Ⅰ 肌酸激酶同工酶质量 急性心肌梗死 

分 类 号：Q513[生物学—生物化学]