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使用生物芯片心脏阵列技术的多标志物方法用于急性冠状动脉综合征患者的早期诊断

Multi-Marker Approach with the Use of Biochip Cardiac Array Technology for Early Diagnosis in Patients with Acute Coronary Syndromes.

作者信息

Sawicki Marcin, Sypniewska Grazyna, Krintus Magdalena, Kozinski Marek, Ostrowska-Nowak Joanna, Pilaczyńska-Cemel Marta, Budzbon Dominika, Jacek Kubica

机构信息

Department of Laboratory Medicine, University of Nicolaus Copernicus , Bydgoszcz, Poland.

Department of Cardiology and Internal Medicine, Collegium Medicum, University of Nicolaus Copernicus , Bydgoszcz, Poland

出版信息

EJIFCC. 2008 Dec 20;19(3):160-71. eCollection 2008 Dec.

Abstract

INTRODUCTION

Diagnosis of acute coronary syndrome (ACS) is frequently a challenging task while immediate risk stratification remains crucial for the prompt implementation of appropriate therapy in this setting. The prolonged release pattern of both CK-MB mass and cardiac troponins makes it difficult to identify the origin of recent chest pain, thus a combination of early and later biomarkers might further facilitate the differential diagnosis. The study was designed to evaluate the efficacy of multi-marker approach using biochip array technology in identifying ACS shortly after the symptom onset.

MATERIAL AND METHODS

The study group consisted of 42 patients suspected for ACS. Subjects were diagnosed as presenting with unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI). Biomarkers in the serum were determined twice: on admission (≤6 hours from the chest pain onset) and after next 6 hours. Cardiac troponin I was measured by routine sensitive automated assay (STAT cTnI) while other 6 cardiac markers (heart-fatty acid binding protein - H-FABP, myoglobin, glycogen phosphorylase BB, cTn I, CK-MB mass and carbonic anhydrase III) were assessed using biochip array technology.

RESULTS

STAT cTnI concentrations within 6 hours from the symptom onset were elevated over the 99(th) percentile for reference population in 83.3% of subjects but none reached the cut-off value for myocardial infarction. Instead, H-FABP demonstrated a very good efficacy in early detection of ACS (90.5%), better than myoglobin and CK-MB mass. Sensitivity of H-FABP calculated for NSTEMI/STEMI subjects reached 100%. The diagnostic efficacy of troponin, myoglobin and CK-MB mass assay markedly increased within 12 hours. It was only for the patients with UA that the cardiac panel was not efficient in the early stratification of risk.

CONCLUSIONS

A multi-marker strategy with H-FABP and highly sensitive troponin included enhances the early diagnosis and decision making process in patients with ACS. A new biochip cardiac array technology may serve as a powerful tool for ACS detection in the clinical practice.

摘要

引言

急性冠状动脉综合征(ACS)的诊断常常具有挑战性,而即时风险分层对于在此情况下迅速实施适当治疗仍然至关重要。肌酸激酶同工酶质量(CK-MB mass)和心肌肌钙蛋白的延长释放模式使得难以确定近期胸痛的来源,因此早期和晚期生物标志物的联合使用可能会进一步促进鉴别诊断。本研究旨在评估使用生物芯片阵列技术的多标志物方法在症状发作后不久识别ACS的有效性。

材料与方法

研究组由42例疑似ACS的患者组成。受试者被诊断为不稳定型心绞痛(UA)、非ST段抬高型心肌梗死(NSTEMI)或ST段抬高型心肌梗死(STEMI)。血清中的生物标志物测定两次:入院时(胸痛发作后≤6小时)和接下来的6小时后。心肌肌钙蛋白I通过常规敏感自动检测法(STAT cTnI)测量,而其他6种心脏标志物(心脏脂肪酸结合蛋白-H-FABP、肌红蛋白、糖原磷酸化酶BB、cTn I、CK-MB mass和碳酸酐酶III)使用生物芯片阵列技术进行评估。

结果

症状发作后6小时内,83.3%的受试者的STAT cTnI浓度超过参考人群的第99百分位数,但无一达到心肌梗死的临界值。相反,H-FABP在ACS的早期检测中显示出非常好的效果(90.5%),优于肌红蛋白和CK-MB mass。计算得出的NSTEMI/STEMI受试者的H-FABP敏感性达到100%。肌钙蛋白、肌红蛋白和CK-MB mass检测的诊断效果在12小时内显著提高。仅对于UA患者,心脏标志物组合在早期风险分层中无效。

结论

包含H-FABP和高敏肌钙蛋白的多标志物策略可增强ACS患者的早期诊断和决策过程。一种新的生物芯片心脏阵列技术可作为临床实践中检测ACS的有力工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c82/4975262/b60a3e2ae4ed/ejifcc-19-160-g001.jpg

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