[心脏脂肪酸结合蛋白在非ST段抬高型急性冠状动脉综合征早期住院患者中的诊断价值]

[Diagnostic value of heart fatty-acid binding protein in early hospitalized patients with non ST elevation acute coronary syndrome].

作者信息

Trifonov I R, Katrukha A G, Iavelov I S, Averkov O V, Gratsianskiĭ N A

出版信息

Kardiologiia. 2003;43(5):4-8.

Abstract

BACKGROUND

Heart fatty-acid-binding protein (FABP) is supposed to be the most sensitive biomarker of myocardial necrosis in patients with Q-wave myocardial infarction (MI) and non-diagnostic ECG during first hours after onset of symptoms. However, diagnostic value of FABP in patients with non-ST elevation acute coronary syndrome (NSTEACS) is not well established.

AIM

To elucidate diagnostic value of FABP in patients with NSTEACS hospitalized within time interval considered to be too early for a majority of biochemical tests.

MATERIAL AND METHODS

FABP levels were measured by immunofluorometry (HyTest, Finland) in 44 patients (26 men, mean age 69+/-8.9 years) at admission within 6 hours (median - 2 h) from onset of index attack of angina and in 6, 12, 24 hours after onset of pain. Cut off FABP level was 12 ng/ml. Serum cardiac troponin I was measured for diagnosis of MI on admission and twice during first 24 hours of hospital stay. Cut off TnI level was 0.4 ng/ml.

RESULTS

Acute MI was diagnosed by TnI above cut off in 31 patients (70.5%). There were no new-Q-wave MIs. Average ratio of observed serum FABP level to diagnostic cut off value on admission and in 6, 12, 24 hours after onset of pain was higher in patients with MI than in patients with unstable angina (1.01, 1.53, 0.81, 0.66 and 0.78, 0.51, 0.65, 0.56, respectively). The difference was maximally significant in 6 hours after onset of pain (p=0.018). Among patients with MI admission FABP compared with admission TnI more frequently exceeded diagnostic level (in 18 vs 9 patients, respectively, p=0.009). Sensitivity and specificity of admission levels of FABP and TnI for diagnosis of MI were 58 and 85%, 29% and 100%, respectively.

CONCLUSION

In patients with NSTEACS during first 6 hours after pain onset FABP compared with TnI has greater sensitivity for detection of MI and sufficient specificity. FABP can be used as additional diagnostic tool for MI detection in early admitted patients with NSTEACS.

摘要

背景

心脏脂肪酸结合蛋白（FABP）被认为是Q波心肌梗死（MI）患者以及症状发作后最初几小时内心电图无诊断意义的患者中最敏感的心肌坏死生物标志物。然而，FABP在非ST段抬高急性冠状动脉综合征（NSTEACS）患者中的诊断价值尚未明确。

目的

阐明FABP在NSTEACS患者中的诊断价值，这些患者在被认为对大多数生化检查来说过早的时间间隔内住院。

材料和方法

采用免疫荧光法（芬兰HyTest公司）对44例患者（26例男性，平均年龄69±8.9岁）进行检测，在心绞痛发作后6小时内（中位数 - 2小时）入院时以及疼痛发作后6、12、24小时检测FABP水平。FABP水平的临界值为12 ng/ml。入院时及住院的前24小时内两次检测血清心肌肌钙蛋白I以诊断MI。TnI水平的临界值为0.4 ng/ml。

结果

31例患者（70.5%）TnI高于临界值，诊断为急性MI。无新的Q波MI。MI患者疼痛发作后入院时、6、12、24小时观察到的血清FABP水平与诊断临界值的平均比值高于不稳定型心绞痛患者（分别为1.01、1.53、0.81、0.66和0.78、0.51、0.65、0.56）。疼痛发作后6小时差异最为显著（p = 0.018）。MI患者入院时FABP超过诊断水平的频率高于入院时TnI（分别为18例和9例，p = 0.009）。入院时FABP和TnI水平对MI诊断的敏感性和特异性分别为58%和85%、29%和100%。