H-FABP、TpP和sTM在老年非ST段抬高型心肌梗死早期诊断的临床价值  

Clinical value of H-FABP, TpP and sTM in early diagnosis of non ST segment elevation myocardial infarction in elderly patients

作　　者：胡晓星 彭亚飞[2] HU Xiaoxing;PENG Yafei(Medical Department of Training Base of Armed Police Police Academy in Guangzhou,Guangzhou,Guangzhou 510507,China)

机构地区：[1]武警广东省总队医院驻武警警官学院训练基地门诊部,广州市510507 [2]福建医科大学附属协和医院

出　　处：《河北医药》2019年第21期3249-3252,共4页Hebei Medical Journal

摘　　要：目的评估心肌脂肪酸结合蛋白(H-FABP)、血栓前体蛋白(TpP)和可溶性血栓调节蛋白(sTM)水平在老年非ST段抬高型心肌梗死(NSTEMI)早期诊断的临床价值。方法选择2017年1月至2018年12月就诊的非ST段抬高型冠脉综合征患者119例,按照诊断标准分为不稳定型心绞痛(UA)组(46例)和NSTEMI组(73例),选择同期非冠心病患者30例为对照组。采用酶联免疫吸附法检测3组H-FABP、TpP和sTM水平。比较3组血清H-FABP、TpP和sTM水平的变化,观察NSTEMI患者血清H-FABP、TpP和sTM水平与疾病严重程度的关系,发生NSTEMI的Logistics分析和相互之间相关性分析及诊断NSTEMI的灵敏度和特异性。结果 NSTEMI组的血清H-FABP、TpP和sTM水平明显高于UA组和对照组(P<0.01),并且UA组的水平明显高于对照组(P<0.01)。NSTEMI患者血清H-FABP、TpP和sTM水平随着疾病严重程度升高而升高(P<0.01)。NSTEMI患者血清H-FABP水平与TpP(r=0.768,P<0.01)和sTM(r=0.866,P<0.01)水平呈正相关,而血清TpP水平与sTM水平呈正相关(r=0.658,P<0.01)。通过对血清H-FABP、TpP和sTM水平的Logistics分析发现H-FABP、TpP和sTM是检测发生NSTEMI的独立因素(P<0.01)。在诊断NSTEMI方面,联合检测的最佳截断值为>0.513,其灵敏度为93.2%,特异性为93.5%,其AUC为0.981联合检测的曲线下面积明显优于H-FABP(Z=4.227,P<0.01),TpP(Z=3.570,P<0.01)和sTM(Z=4.447,P<0.01),而血清H-FABP、TpP和sTM的曲线下面积间比较差异无统计学意义(P>0.05)。结论血清H-FABP、TpP和sTM水平对于鉴别UA和NSTEMI具有较高的灵敏度和特异性,联合3个指标较单个指标诊断NSTEMI具有更高的诊断效率,具有重要的临床价值。Objective To evaluate the clinical value of heart type fatty acid binding protein(H-FABP), thrombus precursor protein(TpP) and soluble thrombomodulin(sTM) in early diagnosis of non ST segment elevation myocardial infarction in elderly patients.Methods A total of 119 patients with non ST segment elevation coronary syndrome who were admitted and treated in our hospital from January 2017 to February 2018 were divided into unstable angina pectoris(UA) group(n=46) and non ST segment elevation myocardial infarction(NSTEMI) group(n=73) according to the diagnostic criteria. Meahwhile the other 30 patients with non coronary heart disease were enrolled as control group. The levels of H-FABP, TpP and sTM were measured by enzyme linked immunosorbent assay. The changes of serum levels of H-FABP, TpP and sTM were observed and compared among the three groups.In addition the correlation between the serum levels of H-FABP, TpP, sTM and the disease severity was analyzed.The logistics analysis of NSTEMI occurrence and correlation analysis between the above indexes each other was performed.Besides the sensitivity and specificity of those indexes in diagnosis of NSTEMI were also analyzed.Results The serum levels of H-FABP, TpP and sTM in NSTEMI group were significantly higher than those in UA group and control group(P<0.01),moreover,the levels of the above indexes in UA group were significantly higher than those in control group(P<0.01). The serum levels of H-FABP, TpP and sTM in patients with NSTEMI were increased with the increase of severity of the disease(P<0.01). In addition the serum levels of H-FABP in patients with NSTEMI were positively correlated with those of TpP(r=0.768,P<0.01) and sTM(r=0.866,P<0.01),and the serum levels of TpP were positively correlated with those of sTM(r=0.658,P<0.01). Logistic analysis showed that H-FABP, TpP and sTM were independent factors in detecting the occurrence of NSTEMI(P<0.01). In the diagnosis of NSTEMI, the optimal cutoff value of combined detection was more than 0.513, and the sensitivit

关 键 词：心肌脂肪酸结合蛋白 血栓前体蛋白 可溶性血栓调节蛋白 非ST段抬高型心肌梗死 不稳定型心绞痛 

分 类 号：R542.22[医药卫生—心血管疾病]