快速定性色谱免疫分析法测定心型脂肪酸结合蛋白对非ST段抬高型急性冠状动脉综合征患者微小心肌损伤检测的诊断价值

Diagnostic value of heart-type fatty acid binding protein determined by the rapid qualitative chromatographic immunoassay method for the detection of minor myocardial damage in patients presenting with non-ST elevation acute coronary syndrome.

作者信息

Çavuşoğlu Yüksel, Gök Bülent, Demirüstü Canan, Birdane Alparslan, Görenek Bülent, Ata Necmi

机构信息

Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskişehir-Turkey.

出版信息

Anadolu Kardiyol Derg. 2012 Nov;12(7):584-90. doi: 10.5152/akd.2012.185. Epub 2012 Jul 17.

DOI:10.5152/akd.2012.185

PMID:22804980

Abstract

OBJECTIVE

The aim of this prospective study was to evaluate the diagnostic value of heart-type fatty acid binding protein (H-FABP) determined by qualitative immunoassay method for the detection of minor myocardial damage (MMD) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS).

METHODS

The study consisted of 62 patients with NSTE-ACS. Cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) values were measured at arrival. Myoglobin and H-FABP were obtained if cTnI level was found to be elevated. A control group included 20 subjects with normal cTnI and CK-MB values. H-FABP was determined by a rapid qualitative immunochromatographic test. Patients were classified as MMD-ACS group if they had abnormal cTnI and normal CK-MB (n=24) and as NSTEMI-ACS group if they had elevated both cTnI and CK-MB (n=38). The diagnostic accuracy of H-FABP for minor myocardial damage was determined using ROC analysis.

RESULTS

The sensitivity of the H-FABP was significantly higher for NSTEMI-ACS than for MMD-ACS (44.7% vs 0%, p<0.001) and its specificity was 95% for both groups. The diagnostic efficacy rates for myoglobin and H-FABP were 75% and 43% for MMD-ACS, 74% and 62% for NSTEMI-ACS. Positive predictive value for H-FABP and myoglobin were found to be 0% and 80.8% in MMD-ACS, 94% and 87% in NSTEMI-ACS and negative predictive value was 44% and 69.5% in MMD-ACS, 47.5% and 59% in NSTEMI-ACS, respectively. AUC for myoglobin was significantly greater than that for H-FABP in MMD-ACS group (0.754 vs 0.525, p=0.027). The sensitivity of the H-FABP was significantly higher in patients with >3-fold increase in cTnI than those with <3-fold increase in cTnI (46.8% vs. 6.7%, p<0.001). A positive correlation was found between the magnitude of cTnI rise and H-FABP results (r=0.45, p<0.001).

CONCLUSIONS

H-FABP determined by the rapid qualitative immunochromatographic test has almost similar diagnostic value to that of myoglobin for identifying NSTEMI-ACS, however, does not seem to represent diagnostic potential for the detection of MMD.

摘要

目的

本前瞻性研究旨在评估通过定性免疫测定法测定的心型脂肪酸结合蛋白（H-FABP）对检测非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者微小心肌损伤（MMD）的诊断价值。

方法

该研究纳入了62例NSTE-ACS患者。入院时测定心肌肌钙蛋白I（cTnI）和肌酸激酶MB同工酶（CK-MB）值。若发现cTnI水平升高，则检测肌红蛋白和H-FABP。对照组包括20例cTnI和CK-MB值正常的受试者。通过快速定性免疫层析试验测定H-FABP。cTnI异常而CK-MB正常的患者被分类为MMD-ACS组（n = 24），cTnI和CK-MB均升高的患者被分类为NSTEMI-ACS组（n = 38）。使用ROC分析确定H-FABP对微小心肌损伤的诊断准确性。

结果

H-FABP对NSTEMI-ACS的敏感性显著高于MMD-ACS（44.7%对0%，p<0.001），两组的特异性均为95%。MMD-ACS组中肌红蛋白和H-FABP的诊断有效率分别为75%和43%，NSTEMI-ACS组分别为74%和62%。MMD-ACS组中H-FABP和肌红蛋白的阳性预测值分别为0%和80.8%，NSTEMI-ACS组分别为94%和87%，阴性预测值在MMD-ACS组分别为44%和69.5%，在NSTEMI-ACS组分别为47.5%和59%。MMD-ACS组中肌红蛋白的AUC显著大于H-FABP（0.754对0.525，p = 0.027）。cTnI升高>3倍的患者中H-FABP的敏感性显著高于cTnI升高<3倍的患者（46.8%对6.7%，p<0.001）。发现cTnI升高幅度与H-FABP结果之间存在正相关（r = 0.45，p<0.001）。