摘要
目的探讨心脏型脂肪酸结合蛋白(H-FABP)、肌红蛋白(Mb)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)及超敏C-反应蛋白(hs-CRP)单独检测及联合检测对急性心肌梗死(AMI)的诊断价值。方法选择82例AMI胸痛患者(A组)、74例非AMI胸痛患者(B组)及80例健康者(C组)。A、B组患者入院时0h、3h、12h、24h、3d分别抽取静脉血,C组早晨空腹抽取静脉血。采用免疫透射比浊法、化学发光免疫分析法、免疫层析法测定H-FABP、Mb、cTnT、CK-MB和hs-CRP,比较它们在胸痛发作后不同时间对AMI诊断的阳性率,比较A组患者胸痛发作12h各项指标单独检测及H-FABP、cTnT、CK-MB3项联合检测诊断AMI的敏感度、特异度、阳性预测值(PPV)及阴性预测值(NPV)。结果胸痛发作后3h时H-FABP对AMI诊断的阳性率最高,为96.3%;MB在胸痛发作后12h阳性率最高,为90.2%;cTnT在胸痛发作后24h阳性率最高,为95.1%;CK-MB在胸痛发作后12h阳性率最高,为96.3%;hs-CRP在胸痛发作后24h阳性率最高,为85.4%。胸痛发作后12h单独检测5项指标,发现CK-MB的敏感度最高(96.3%),H-FABP的特异度最高(96.0%),H-FABP的PPV最高(96.3%),CK-MB的NPV最高(95.8%),H-FABP、cTnT、CK-MB联合检测诊断AMI的敏感度、特异度、PPV、NPV最高,分别为97.6%、100.0%、100.0%和97.4%。结论H-FABP、Mb、cTnT、CK-MB、hs-CRP单独检测对AMI的诊断各有优劣,H-FABP、cTnT、CK-MB联合检测诊断AMI的特异度和PPV最高,可以减少误诊。
Objective To explore the value of single or joint use of heart fatty acid binding protein （ H - FABP）, myoglobin （Mb）, cardiac troponin T （cTnT）, MB isoenzyme of ereatine kinase （CK - MB ）-, hypersensitive C reactive protein （hs - CRP） in diagnosis of acute myocardial infarction （AMI）. Methods Venous blood was drawn from 82 AMI chest pain patients （group A）, 74 non -AMI chest pain patients （group B） at hours O, 3, 12, 24, days 3 after admission, and morning fasting venous blood from 80 healthy subjects （ group C）. H - FABP, Mb, cTnT, CK - MB and hs - CRP were determined, by immune turbidimetric method, chemiluminescence immunoassay, immune chromatography. Their positive rates to AMI diagnosis at different time points were compared after chest pain onsets. All indexes 12h after onset of chest pains and the sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of combined H -FABP, cTnT, CK -MB in diagnosis of AMI were also compared. Results The positive rate of H - FABP to AMI diagnosis was the highest at hours 3 after on- set （96.3%）, that of Mb at hours 12 （90.2%）, that of cTnT at hours 24 （95.1%）, that of CK -MB at hours 12 （96. 3% ） , that of hs - CRP at hours 24 （85.4%） . When 5 indexes were independently detected at hours 12 after onset, sensitivity of CK - MB （96. 3% ） , specificity and PPV of H - FABP （96. 0%, 96. 3% ）, NPV of CK - MB （95. 8% ） were noted the highest. The sensitivity, specificity, PPV, NPV of combined H - FABP, cTnT, CK - MB in AMI diagnosis were 97.6%, 100. 0%, 100. 0%, 97.4%, respectively. Condusion Single detection of H - FABP, Mb, cTnT, CK - MB, hs - CRP has advantages and disadvantages in AMI diagnosis. The specificity and positive predictive value of combined H - FABP, cTnT, CK- MB are the highest, which can reduce misdiagnoses.
出处
《中国全科医学》
CAS
CSCD
北大核心
2010年第3期242-244,共3页
Chinese General Practice
