心肌损伤标志物单独及联合检测在急性心肌梗死的诊断价值  

Diagnostic values of H-FABP and other myocardial injury markers in a separate or joint detection of acute myocardial infarction:a comprehensive evaluation

作　　者：渠梦茹 张桐硕[1] 房加雄 李艳秋[1] 

机构地区：[1]武警后勤学院附属医院检验科,天津300162 [2]武警浙江总队温州市支队,浙江温州325000 [3]武警8755部队,云南蒙自661100

出　　处：《武警后勤学院学报（医学版）》2017年第2期118-122,共5页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】评估心型脂肪酸结合蛋白(heart type-fatty acid binding protein,H-FABP)、心肌肌钙蛋白I(cardiac troponin I,cTnI)、肌红蛋白(myoglobin,MYO)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)在单独或者联合检测急性心肌梗死(acute myocardial infarction,AMI)时的诊断效能,以考证这种标记物在临床应用中的实际价值。【方法】选择2015年4月至2015年8月因心源性胸痛就诊于我院的患者中进行H-FABP、cTnI、MYO、CK-MB检测者,共92例,其中诊断为AMI组44例,非AMI对照组48例,接诊即刻(0.60±0.25)h采静脉血8 ml检测含量水平,通过Logistic回归分析和ROC曲线评价诊断效能。【结果】H-FABP单独检测AMI时AUC为0.799(95%CI:0.702~0.896),cTnI、MYO、CK-MB的AUC分别为0.913(95%CI:0.850~0.976)、0.813(95%CI:0.727~0.899)、0.820(95%CI:0.735~0.905)。"H-FABP+cTnI+MYO"联合检测诊断AMI的AUC为0.928(95%CI:0.876~0.980)高于上述生化标志物单独检测和其他联合检测方案的诊断效能,"H-FABP+cTnI"联合检测诊断AMI的AUC为0.916(95%CI:0.856~0.977),联合检测在诊断AMI中较单项检测更具准确性。【结论】联合检测与单独使用一种指标比较准确性更高,对AMI的评估更具优势。H-FABP在临床实际诊断AMI中,应综合检测时间考虑,H-FABP联合cTnI、CK-MB、MYO检测,其诊断性能大大提高,发挥了较好的互补作用。[Objective]To evaluate the diagnostic values of heart-type fatty acid binding protein （H-FABP）, cardiac troponin I （cTnI）, myoglobin （MYO） and creatine kinase isoenzyme （CK-MB） in a separate or joint detection of acute myocardial infarction （AMI）. [ Methods ] A total of 92 patients with cardiac chest pain diseases were selected in our hospital from April 2015 to August 2015. Their serum levels of H-FABP, cTnI, MYO and CK-MB were detected. There were 44 patients in the AMI group and 48 cases in the non-AMI group. The marker levels in 8 ml venous blood were detected within （0.60 ± 0.25） h in admission. The diagnostic values were evaluated via Logistic regression analysis and ROC curve. [ Results ] In the separate detection, the AUC values of H-FABP, cTnI, MYO and CK-MB were 0.799 （95%CI： 0.702-0.896）, 0.913 （95%CI： 0.850-0.976）, 0.813 （95%CI： 0.727-0.899） and 0.820 （95%CI： 0.735-0.905）. The AUC of ＂H-FABP＋cTnI＋ MYO＂ for AMI was 0.928 [95%CI （0.876-0.980）], which was higher than those of separate testing and other joint detection programs. The AUC of ＂H-FABP＋cTnI＂ was 0.916 （95%CI： 0.856-0.977）, which was more accurate than that of single detection in the diagnosis for AMI. [ Conclusion ] Joint detection is more accurate than single detection and has an advantage in the evaluation of AMI. In the clinical diagnosis for AMI, the testing time should be considered; the detection of H-FABP combined with cTnI, CK-MB and MYO could greatly improve the diagnostic performance and play a good complemental3, role.

关 键 词：心型脂肪酸结合蛋白 心肌梗死 ROC曲线 LOGISTIC回归分析 

分 类 号：R446.1[医药卫生—诊断学]