三种心肌损伤标志物在急性心肌梗死早期诊断中的应用价值

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (1): 82-86.

三种心肌损伤标志物在急性心肌梗死早期诊断中的应用价值

浦春¹, 陶青松¹，朱翔²，秦明明²，武其文¹，冯钢¹

¹皖南医学院第一附属医院检验科，芜湖 241001，安徽；²皖南医学院，芜湖 241000，安徽

收稿日期:2016-08-10 修回日期:2016-12-09 出版日期:2017-01-26 发布日期:2017-01-23
作者简介:浦春，男，本科，副教授，主要从事临床检验诊断学研究。 Tel: 0553-5739440 E-mail:philipcpu@163.com
基金资助:
国家高技术研究发展计划（863计划）项目（2011AA02A111）；国家级大学生创新创业训练计划项目(201410368030)

Value of three cardiac markers in the early diagnosis of acute myocardial infarction

PU Chun ¹, TAO Qingsong¹, ZHU Xiang ², QIN Mingming², WU Qiwen¹, FENG Gang¹

¹Department of Laboratory Medicine, the First Affiliated Hospital of Wannan Medical College，Wuhu 241001，Anhui，China;² Wannan Medical College, Wuhu 241000，Anhui，China

Received:2016-08-10 Revised:2016-12-09 Online:2017-01-26 Published:2017-01-23

摘要/Abstract

摘要：

目的:比较三种心肌损伤标志物在急性心肌梗死早期诊断中的应用价值。方法: 选取本院的急性心肌梗死患者90例，设为实验组，按发病时间分为0～3 h组34例和3～6 h组56例。另选取肌肉损伤患者20例，80例健康体检者作为对照组。同时测定血清心型脂肪酸结合蛋白(heart fatty acid-binding protein，H-FABP)、高敏肌钙蛋白(high-sensitivity cardiac troponin I，hs-cTnI)、肌钙蛋白(cardiac troponin I，cTnI)和肌红蛋白(myoglobin，MYO)的浓度。结果: 0～3 h组和3～6 h组患者血清H-FABP、hs-cTnI和MYO的浓度均高于对照组(P＜0.01)；肌肉损伤患者血清MYO浓度高于对照组(P＜0.01)；在AMI发病的最初0～3 h和3～6 h内，H-FABP和hs-cTnI的特异性及敏感性均高于MYO；在AMI发病的早期hs-cTnI较cTnI敏感度高。结论:H-FABP和hs-cTnI可作为AMI早期诊断的良好血清标志物。

关键词: 急性心肌梗死, 高敏肌钙蛋白, 心型脂肪酸结合蛋白, 肌红蛋白, 诊断价值

Abstract:

AIM: To explore the value of three cardiac markers in the early diagnosis of acute myocardial infarction(AMI). METHODS: 90 cases of AMI were selected as the experimental group, and were further divided into the (0-3 h) group (34 cases) and (3-6 h) group (56 cases) according to the on-set time. 80 cases of healthy check-ups were recruited in the control group, and another 20 cases of muscle injury were also selected in this experiment. High-sensitivity cardiac troponin I(hs-cTnI) ，heart fatty acid-binding protein (H-FABP) and myoglobin(MYO) were measured simultaneously. RESULTS:Serum concentrations of H-FABP, hs-cTnI and MYO in the 34 AMI patients of (0-3 h) group and 56 AMI patients level of the experimental group were higher than those of control group(P＜0.01); serum concentrations of MYO in patients with muscle injury were higher than those of control group(P＜0.01); the specificity and sensitivity of H-FABP and cTnI were higher than those of MYO within the early onset time of AMI (0-3 h, 3-6 h); hs-cTnI was more sensitive than cTnI in the early onset of AMI. CONCLUSION: H-FABP and hs-cTnI can be referential serum markers for early diagnosis of AMI.

Key words: acute myocardial infarction, high-sensitivity cardiac troponin I, heart fatty acid-binding protein, myoglobin, diagnostic value

中图分类号:

R972

浦春, 陶青松，朱翔，秦明明，武其文，冯钢. 三种心肌损伤标志物在急性心肌梗死早期诊断中的应用价值[J]. 中国临床药理学与治疗学, 2017, 22(1): 82-86.

PU Chun, TAO Qingsong, ZHU Xiang, QIN Mingming, WU Qiwen, FENG Gang. Value of three cardiac markers in the early diagnosis of acute myocardial infarction[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(1): 82-86.

参考文献

［1］Alhashemi JA. Diagnostic accuracy of a bedside qualitative immunochromatographic test for acute myocardial infarction［J］. Am J Emerg Med, 2006, 24（2）:149-155.
［2］中华医学会心血管病学分会·中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南［J］. 中华心血管病杂志,2010,38(8):675-687.
［3］Liebetrau C, Nef HM, Do rr O, et al. Release kinetics of early ischaemic biomarkers is in a clinical model of a cute myocardial infarction［J］. Heart, 2014, 100(8):652-657.
［4］Flook N, Unge P, Agréus L, et al. Clinical Review: Approach to managing undiagnosed chest pain- Could gastro-oesophageal reflux disease be the cause ［J］? Can Fam Physician, 2007,53（2）:261-266.
［5］Alhashemi JA. Diagnostic accuracy of a bedside qualitative immunochromatographic test for acute myocardial infarction［J］. Am J Emerg Med, 2006, 24（2）:149-155.
［6］Adams J, Trent R, Rawles J. Earliest electrocardiographic evidence of myocardial infarction: implications for thrombolytic treatment［J］. BMJ,1993,307（6901）:409-413.
［7］Figiel L，Kasprzak JD，Peruqa J，et al. Heart-type fatty acid binding protein-a reliable marker of myocardial necrosis in a heterogeneous group of patients with acute coronary syndrome without persistent ST elevation［J］. Kardiol Pol，2008，66(3): 253-259，260-261．
［8］Alhadi HA, Fox KAA. Do we need additional markers of myocyte necrosis: the potential value of heart type fatty acid binding protein［J］. Q J Med, 2004, 97:187-198.
［9］Vork MM, Glatz JF, Surtel DA, et al. A sandwich ELISA for the determination of rat H-FABP using Streptavidin-Biotin system［J］. Biochem Biophys Acta, 1991, 1075(3):199-205.
［10］Glatz JF, van der Vusse GJ, Simoons ML, et al. Fatty acid binding protein and early detection of acute myocardial infarction［J］. Clin Chem Acta, 1998,272(1):87-92.
［11］Banu S, Tanveer S, Manjunath CN. Comparative study of high sensitivity troponin T and heart-type fatty acid-binding protein in STEMI patients［J］. Saudi J Biol Sci, 2015, 22(1):56-61.
［12］Ramaiah JH, Ramegowda RT, Ashalatha B, et al. Heart-type fatty acid-binding protein (H-FABP) as a novel biomarker for the early diagnosis of acute myocardial infarction in comparison with cardiac troponin T［J］. J Evolution Med Dental Sci,2013，2(1):8-18.
［13］Chan CP, Sum KW, Cheung KY, et al. Development of a quantitative lateral-flow assay for rapid detection of fatty acid-binding protein［J］. J Immunol Methods, 2003, 279(1/2):91-100.
［14］Reichlin T, Hochholzer W, Bassetti S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays［J］. N Engl J Med, 2009, 361（9）:858-867.
［15］Diercks DB, Peacock WF 4th, Hollander JE, et al. Diagnostic accuracy of a point-of-care troponin I assayfor acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain［J］. Am Heart J, 2012, 163（1）:74-80.
［16］Meune C, Reichlin T, Irfan A, et al. How safe is the outpatient management of patients with acute chest pain and mildly increased cardiactroponin concentrations［J］? Clin Chem, 2012, 58(5):916-924.
［17］Chan D，Ng LL．Biomarkers in acute myocardial infarction［J］. BMC Med，2010, 8: 34．

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