H-FABP、CK-MB和Hcy及其联合检测评估急性中毒严重程度的临床价值  

Clinical value of H-FABP,CK-MB and Hcy and their combined detection in evaluating the severity of acute poisoning

作　　者：王玺凯 王艳丽 杜永锋[1] 马景晶 WANG Xikai;WANG Yanli;DU Yongfeng;MA Jingjing(Department of Occupational Diseases,Xi’an Central Hospital,Xi’an,Shannxi 710003,China)

机构地区：[1]陕西省西安市中心医院职业病科,710003

出　　处：《重庆医学》2023年第10期1460-1463,1468,共5页Chongqing medicine

基　　金：陕西省重点研发计划项目(2017SF-253);西安市卫生健康委员会科研项目(2023YB01)。

摘　　要：目的评估心脏型脂肪酸结合蛋白(H-FABP)、肌酸激酶同工酶(CK-MB)和同型半胱氨酸(Hcy)及三者联合检测评估急性中毒严重程度的效能。方法选取2017年7月至2020年9月该院确诊急性中毒患者164例作为研究对象,根据中毒类型分为一氧化碳(CO)中毒组(44例)、酒精中毒组(46例)、药物中毒组(74例),并进一步根据病情严重程度分级标准分为轻度和中/重度患者。另选取同期体检健康者50例作为对照组。检测所有受试者血清H-FABP、CK-MB和Hcy水平进行比较分析,绘制受试者工作特征(ROC)曲线,评估H-FABP、CK-MB和Hcy及三者联合检测判断急性中毒严重程度的效能。结果3个中毒组血清H-FABP、CK-MB和Hcy水平均明显高于对照组(P<0.01)。3个中毒组中/重度中毒患者血清H-FABP水平均明显高于轻度中毒患者(P<0.01);CO中毒组和药物中毒组中/重度中毒患者血清CK-MB水平均明显高于轻度中毒患者(P<0.01),而在酒精中毒组中无明显差异(P=0.389);酒精中毒组和药物中毒组中/重度中毒患者血清Hcy水平明显高于轻度中毒患者(P<0.01),而在CO中毒组中无明显差异(P=0.06)。ROC曲线分析显示,H-FABP、CK-MB、Hcy联合检测的ROC曲线下面积(AUC)最高(0.910),且具有较高的灵敏度(80.4%)和特异度(89.5%);H-FABP、CK-MB、Hcy检测的AUC分别为0.854、0.833、0.735,截断值分别为4.08 ng/mL、27.70 U/L、14.24μmol/L。结论H-FABP、CK-MB和Hcy联合检测对判断急性中毒严重程度具有重要价值。Objective To evaluate the efficacy of heat-fatty acid binding protein(H-FABP),creatine kinase isoenzymes(CK-MB)and homocysteine(Hcy)and the combined detection of the three indicators in evaluating the severity of acute poisoning.Methods A total of 164 patients diagnosed with acute poisoning in the hospital from July 2017 to September 2020 were selected as the research objects,and were divided into the following groups according to the type of poisoning:the carbon monoxide(CO)poisoning group(44 cases),the alcohol poisoning group(46 cases)and the drug poisoning group(74 cases),and further divided into the mild and moderate/severe patients according to the grading criteria of severity.Another 50 healthy individuals who underwent physical examination during the same period were selected as the control group.The serum levels of H-FABP,CK-MB and Hcy were measured in all the subjects for comparative analysis,and the receiver operating characteristic(ROC)curve was plotted to evaluate the performance of H-FABP,CK-MB,Hcy and and their combined detection in determining the severity of acute poisoning.Results The serum H-FABP,CK-MB and Hcy levels were significantly higher in the three poisoning groups than those in the control group(P<0.01).In the three poisoning groups,the serum H-FABP levels were significantly higher in patients with moderate/severe poisoning than those in patients with mild poisoning(P<0.01).The serum CK-MB levels were significantly higher in patients with moderate/severe poisoning in both the drug and CO poisoning groups than those in patients with mild poisoning(P<0.01),but there was no significant difference in the alcohol poisoning group(P=0.389).The serum Hcy levels of patients with moderate/severe poisoning were significantly higher in both the alcohol and drug poisoning groups than those in patients with mild poisoning(P<0.01),but there was no significant difference in the CO poisoning group(P=0.06).The analysis of ROC curve showed that the area under ROC curve(AUC)of the combined detection of H-FA

关 键 词：急性中毒 脂肪酸结合蛋白质 肌酸激酶同工酶 同型半胱氨酸 ROC曲线 

分 类 号：R595[医药卫生—内科学]