即时检测心脏型脂肪酸结合蛋白诊断早期急性心肌梗死。
Point-of-care test of heart-type fatty acid-binding protein for the diagnosis of early acute myocardial infarction.
机构信息
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China.
出版信息
Acta Pharmacol Sin. 2010 Mar;31(3):307-12. doi: 10.1038/aps.2010.2. Epub 2010 Feb 5.
AIM
To investigate the efficacies of point-of-care test of heart-type fatty-acid binding protein (H-FABP) and its combinations with the conventional biomarkers in the diagnosis of early acute myocardial infarction (AMI).
METHODS
227 patients suspected of AMI were consecutively recruited in two centers. Biomarkers including H-FABP, myoglobin (MYO), creatine kinase-myocardial band (CK-MB) and cardiac troponin T (cTnT) were determined simultaneously at admission. AMI was defined according to the universal definition of myocardial infarction. Chi-Square test was adopted for the analysis.
RESULTS
In patients presenting within 12 h of symptom onset, the sensitivity of H-FABP[93.0% (95% CI: 86.6%-96.9%)] was significantly higher than that of initial CK-MB [67.5% (95% CI: 58.1%-76.0%), P<0.0001], cTnT [69.3% (95%CI: 60.0%-77.6%), P<0.0001] and MYO [68.6% (95% CI: 54.1%-80.9%), P<0.05]. The negative predictive value of H-FABP [92.8% (95%CI: 86.3%-96.8%)] was significantly higher than that of initial CK-MB [74.7% (95% CI: 66.8%-81.5%), P<0.001] and cTnT [75.9% (95% CI: 68.1%-82.6%), P<0.001]. The sensitivity of H-FABP+cTnT combination [94.7% (95% CI: 88.9%-98.0%)] was significantly higher than that of admission cTnT [69.3% (95% CI: 60.0%-77.6%), P<0.0001], CK-MB+cTnT [75.4% (95% CI: 66.5%-83.0%), P<0.0001] and MYO+CK-MB+cTnT [74.5% (95% CI: 60.4%-85.7%), P<0.05]. The negative predictive value of H-FABP+cTnT [94.5% (95% CI: 88.4%-98.0%] was significantly higher than that of initial cTnT [75.9% (95% CI: 68.1%-82.6%), P<0.001] and CK-MB+cTnT [79.1% (95% CI: 71.2%-85.6%), P<0.001]. Subgroup analysis showed that the superiorities of both the sensitivities and the negative predictive values of H-FABP and H-FABP+cTnT combination occurred only in patients who presented within 6 h of the symptom onset.
CONCLUSION
Point-of-care test of H-FABP can be used as a valuable biomarker to detect or exclude an early-stage AMI. Combining H-FABP and cTnT provides the best performance for early AMI diagnosis.
目的
研究心脏型脂肪酸结合蛋白（H-FABP）即时检测及其与常规生物标志物联合应用在早期急性心肌梗死（AMI）诊断中的疗效。
方法
连续纳入两个中心 227 例疑似 AMI 的患者。入院时同时测定 H-FABP、肌红蛋白（MYO）、肌酸激酶同工酶-MB（CK-MB）和心肌肌钙蛋白 T（cTnT）等标志物。根据心肌梗死的通用定义诊断 AMI。采用卡方检验进行分析。
结果
在症状发作 12 h 内就诊的患者中，H-FABP 的灵敏度[93.0%（95%CI：86.6%-96.9%）]明显高于初始 CK-MB [67.5%（95%CI：58.1%-76.0%），P<0.0001]、cTnT [69.3%（95%CI：60.0%-77.6%），P<0.0001]和 MYO [68.6%（95%CI：54.1%-80.9%），P<0.05]。H-FABP 的阴性预测值[92.8%（95%CI：86.3%-96.8%）]明显高于初始 CK-MB [74.7%（95%CI：66.8%-81.5%），P<0.001]和 cTnT [75.9%（95%CI：68.1%-82.6%），P<0.001]。H-FABP+cTnT 联合检测的灵敏度[94.7%（95%CI：88.9%-98.0%）]明显高于入院时 cTnT [69.3%（95%CI：60.0%-77.6%），P<0.0001]、CK-MB+cTnT [75.4%（95%CI：66.5%-83.0%），P<0.0001]和 MYO+CK-MB+cTnT [74.5%（95%CI：60.4%-85.7%），P<0.05]。H-FABP+cTnT 的阴性预测值[94.5%（95%CI：88.4%-98.0%）]明显高于初始 cTnT [75.9%（95%CI：68.1%-82.6%），P<0.001]和 CK-MB+cTnT [79.1%（95%CI：71.2%-85.6%），P<0.001]。亚组分析显示，H-FABP 和 H-FABP+cTnT 联合检测的敏感性和阴性预测值的优势仅发生在症状发作 6 h 内的患者中。
结论
即时检测 H-FABP 可作为一种有价值的生物标志物，用于检测或排除早期 AMI。H-FABP 与 cTnT 联合应用可提高早期 AMI 诊断的性能。
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