血清H-FABP联合cTnⅠ诊断入院后胸痛AMI疑似病例的诊断价值
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摘要
目的观察血清心脏型脂肪酸结合蛋白(H-FABP)联合心肌肌钙蛋白Ⅰ(cTnⅠ)诊断入院后胸痛急性心肌梗死(AMI)疑似病例的诊断价值。方法采用等距随机抽样法选取本院2016年1月至2018年4月期间收治的150例疑似AMI的胸病患者为对象。按照超声心动图表现、心电图表现、心肌核素扫描或冠脉造影结果将其分为AMI组(81例)与非AMI组(69例),另选取健康体检者100例作为健康对照组。对比三组H-FABP、cTnⅠ、肌酸激酶同工酶MB(CK-MB)、肌红蛋白(MYO)定性检测结果,分析患者不同发病时间(<3 h、3～6 h、>6 h)四种心肌标志物诊断敏感性和特异性,并观察血清H-FABP+cTnⅠ联合诊断AMI的敏感性与特异性。结果血清H-FABP、cTnⅠ、CK-MB、MYO诊断AMI灵敏度分别为88.75%、63.15%、62.50%、69.62%,特异度分别为94.12%、81.03%、81.76%、84.79%,准确率分别为92.40%、75.60%、75.60%、80.00%,阳性预测值分别为87.65%、59.25%、61.72%、67.80%,阴性预测值分别为94.67%、83.43%、82.24%、85.79%,Kappa值分别为0.82、0.43、0.44、0.54。于胸痛发作<3 h、3～6 h、>6 h三个时间段内,四种标记物中血清H-FABP诊断AMI灵敏度及特异度最高。血清H-FABP联合cTnⅠ诊断AMI灵敏度为97.53%,特异度为76.33%,准确率为83.20%,阳性预测值为66.38%,阴性预测值为98.47%,Kappa值为0.78。结论血清H-FABP联合cTnⅠ诊断AMI灵敏度、特异度均较高,值得临床推广应用。
Objective To observe the diagnostic value of serum heart-type fatty acid binding protein(H-FABP) combined with cardiac troponin Ⅰ(cTnl) in the diagnosis of suspected cases of acute myocardial infarction( AMI) after admission.Methods A total of 150 patients with suspected AMI from January 2016 to April 2018 were selected by isometric random sampling. They were divided into group AMI(81 cases) and non AMI group( 69 cases) according to echocardiographic performance,electrocardiogram,myocardial radionuclide scan or coronary angiography, and 100 cases of healthy physical examination were selected as health control group. The qualitative detection results of H-FABP, cTnⅠ, creatine kinase isoenzyme MB( CK-MB) and myoglobin( MYO) three groups were compared. The sensitivity and specificity of four kinds of myocardial markers in different onset time( <3 h, 3 to 6 h, >6 h) were analyzed, and the sensitivity and specificity of serum H-FABP + cTnⅠ combined diagnosis were observed. Results The sensitivity of serum H-FABP, cTnⅠ, CK-MB and MYO was 88.75%, 63.15%, 62.50% and 69.62%, respectively, and their specificity were 94.12%, 81.03%, 81.76% and84.79%, respectively. The accuracy rates were 92.40%, 75.60%, 75.60% and 80% respectively. The positive predictive values were 87.65%, 59.25%, 61.72%, and 67.80%, respectively. The negative predictive values were 94.67%, 83.43%,82.24%, and 85.79%, respectively, and the Kappa values were 0.82, 0.43, 0.44, and 0.54, respectively. Serum H-FABP was the most sensitive and specific for the diagnosis of AMI in the three periods of chest pain episodes <3 h, 3～6 h,and >6 h. The sensitivity of serum H-FABP + cTnⅠ combined diagnosis of AMI was 97.53%, the specificity was 76.33%, the accuracy was 83.20%, the positive predictive value was 66.38%, the negative predictive value was 98.47%, and the Kappa value was 0.78. Conclusion Serum H-FABP+cTnⅠ combined diagnosis of AMI have high sensitivity and specificity, which should be paid enough attention in clinical practice.
Objective To observe the diagnostic value of serum heart-type fatty acid binding protein(H-FABP) combined with cardiac troponin Ⅰ(cTnl) in the diagnosis of suspected cases of acute myocardial infarction( AMI) after admission.Methods A total of 150 patients with suspected AMI from January 2016 to April 2018 were selected by isometric random sampling. They were divided into group AMI(81 cases) and non AMI group( 69 cases) according to echocardiographic performance,electrocardiogram,myocardial radionuclide scan or coronary angiography, and 100 cases of healthy physical examination were selected as health control group. The qualitative detection results of H-FABP, cTnⅠ, creatine kinase isoenzyme MB( CK-MB) and myoglobin( MYO) three groups were compared. The sensitivity and specificity of four kinds of myocardial markers in different onset time( <3 h, 3 to 6 h, >6 h) were analyzed, and the sensitivity and specificity of serum H-FABP + cTnⅠ combined diagnosis were observed. Results The sensitivity of serum H-FABP, cTnⅠ, CK-MB and MYO was 88.75%, 63.15%, 62.50% and 69.62%, respectively, and their specificity were 94.12%, 81.03%, 81.76% and84.79%, respectively. The accuracy rates were 92.40%, 75.60%, 75.60% and 80% respectively. The positive predictive values were 87.65%, 59.25%, 61.72%, and 67.80%, respectively. The negative predictive values were 94.67%, 83.43%,82.24%, and 85.79%, respectively, and the Kappa values were 0.82, 0.43, 0.44, and 0.54, respectively. Serum H-FABP was the most sensitive and specific for the diagnosis of AMI in the three periods of chest pain episodes <3 h, 3～6 h,and >6 h. The sensitivity of serum H-FABP + cTnⅠ combined diagnosis of AMI was 97.53%, the specificity was 76.33%, the accuracy was 83.20%, the positive predictive value was 66.38%, the negative predictive value was 98.47%, and the Kappa value was 0.78. Conclusion Serum H-FABP+cTnⅠ combined diagnosis of AMI have high sensitivity and specificity, which should be paid enough attention in clinical practice.
引文
[1]刘欢,李艳,许淑文,等.急性心肌梗死合并心功能不全患者的相关危险因素分析[J].中国热带医学,2016,16(3):244-247.
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[4]伍树芝,陈键,秦伟国,等.血清NT-proBNP、HFABP和cTnI在不同病变程度冠心病中的表达特性及临床意义[J].实用预防医学,2016,23(12):1512-1515.
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[8]Huang HL,Zhu S,Wang WQ,et al.Diagnosis of Acute Myocardial Infarction in Hemodialysis Patients With HighSensitivity Cardiac Troponin T Assay[J].Arch Pathol Lab Med,2016,140(1):75-80.
[9]吴铮,李文铮,李世英,等.老年急性心肌梗死患者血小板平均体积与LVEF、hs-CRP及c TnI相关性研究[J].中华全科医学,2016,14(5):746-748.
[10]顾遵才,李勋,王正忠,等.血清心脏肌球蛋白结合蛋白C检测在急性心肌梗死患者诊断中的作用[J].中国动脉硬化杂志,2016,24(9):954-958.
[11]Fan J,Ma J,Xia N,et al.Clinical Value of Combined Detection of CK-MB,MYO,c TnI and Plasma NT-proBNP in Diagnosis of Acute Myocardial Infarction[J].Clin Lab,2017,63(3):427-433.
[12]张新春.探讨急性心肌梗死早期诊断联合检测H-FABP和Hcy的临床价值[J].中国卫生检验杂志,2016,26(18):2652-2654.
[13]孙泽阳,仇海军,杨丽荣.心脏型脂肪酸结合蛋白、肌钙蛋白I和肌酸激酶对急性心肌梗死诊断价值的比较分析[J].中国卫生检验杂志,2017,27(2):211-213.
[14]Ye XD,He Y,Wang S,et al.Heart-type fatty acid binding protein(H-FABP)as a biomarker for acute myocardial injury and long-term post-ischemic prognosis[J].Acta Pharmacol Sin,2018,39(7):1155-1163.
[15]李文强,余宏斌,朱洪斌,等.急性心肌梗死患者心肌损伤标志物检测在早期诊断中的应用价值分析[J].中国循证心血管医学杂志,2017,9(11):1349-1351.
[16]万颖蕾,倪逸敏,顾志冬.心型脂肪酸结合蛋白在急性心肌梗死患者早期诊断中的应用价值[J].诊断学理论与实践,2016,15(6):582-585.
[17]肖亚利,赵敏,吕平,等.血浆microRNA-145表达水平与急性心肌梗死的相关性研究[J].中国热带医学,2017,17(5):506-510.
[18]蔡玲,范雪梅,孙健,等.血清H-FABP和cTnT水平联合测定在急性心肌梗死诊断中的作用[J].临床心血管病杂志,2017,33(7):643-645.
[2]Trambas C,Pickering JW,Than M,et al.Impact of HighSensitivity Troponin I Testing with Sex-Specific Cutoffs on the Diagnosis of Acute Myocardial Infarction[J].Clin Chem,2016,62(6):831-838.
[3]Ge WH,Lin Y,Li S,et al.Identification of Biomarkers for Early Diagnosis of Acute Myocardial Infarction[J].J Cell Biochem,2018,119(1):650-658.
[4]伍树芝,陈键,秦伟国,等.血清NT-proBNP、HFABP和cTnI在不同病变程度冠心病中的表达特性及临床意义[J].实用预防医学,2016,23(12):1512-1515.
[5]Puymirat E,Ducrocq G.Comparison between European Society of Cardiology(ESC)and American College of Cardiology/American Heart Association(ACC/AHA)guidelines for initial management of ST-elevation myocardial infarction(STEMI)[J].Ann Cardiol Angeiol(Paris),2013,62(4):265-268.
[6]中华人民共和国卫生部医政司.全国临床检验操作规程[M].南京:东南大学出版社,2006.
[7]Hueb W,Gersh BJ,Alves da Costa LM,et al.Accuracy of Myocardial Biomarkers in the Diagnosis of Myocardial Infarction After Revascularization As Assessed by Cardiac Resonance:The Medicine,Angioplasty,Surgery Study V(MASS-V)Trial[J].Ann Thorac Surg,2016,101(6):2202-2208.
[8]Huang HL,Zhu S,Wang WQ,et al.Diagnosis of Acute Myocardial Infarction in Hemodialysis Patients With HighSensitivity Cardiac Troponin T Assay[J].Arch Pathol Lab Med,2016,140(1):75-80.
[9]吴铮,李文铮,李世英,等.老年急性心肌梗死患者血小板平均体积与LVEF、hs-CRP及c TnI相关性研究[J].中华全科医学,2016,14(5):746-748.
[10]顾遵才,李勋,王正忠,等.血清心脏肌球蛋白结合蛋白C检测在急性心肌梗死患者诊断中的作用[J].中国动脉硬化杂志,2016,24(9):954-958.
[11]Fan J,Ma J,Xia N,et al.Clinical Value of Combined Detection of CK-MB,MYO,c TnI and Plasma NT-proBNP in Diagnosis of Acute Myocardial Infarction[J].Clin Lab,2017,63(3):427-433.
[12]张新春.探讨急性心肌梗死早期诊断联合检测H-FABP和Hcy的临床价值[J].中国卫生检验杂志,2016,26(18):2652-2654.
[13]孙泽阳,仇海军,杨丽荣.心脏型脂肪酸结合蛋白、肌钙蛋白I和肌酸激酶对急性心肌梗死诊断价值的比较分析[J].中国卫生检验杂志,2017,27(2):211-213.
[14]Ye XD,He Y,Wang S,et al.Heart-type fatty acid binding protein(H-FABP)as a biomarker for acute myocardial injury and long-term post-ischemic prognosis[J].Acta Pharmacol Sin,2018,39(7):1155-1163.
[15]李文强,余宏斌,朱洪斌,等.急性心肌梗死患者心肌损伤标志物检测在早期诊断中的应用价值分析[J].中国循证心血管医学杂志,2017,9(11):1349-1351.
[16]万颖蕾,倪逸敏,顾志冬.心型脂肪酸结合蛋白在急性心肌梗死患者早期诊断中的应用价值[J].诊断学理论与实践,2016,15(6):582-585.
[17]肖亚利,赵敏,吕平,等.血浆microRNA-145表达水平与急性心肌梗死的相关性研究[J].中国热带医学,2017,17(5):506-510.
[18]蔡玲,范雪梅,孙健,等.血清H-FABP和cTnT水平联合测定在急性心肌梗死诊断中的作用[J].临床心血管病杂志,2017,33(7):643-645.