心型脂肪酸结合蛋白联合圆周应变早期诊断非ST段抬高型心肌梗死的临床价值

doi:10.3877/cma.j.issn.2095-655X.2017.02.003

目的

探究联合应用心型脂肪酸结合蛋白(h-FABP)与圆周应变早期诊断非ST段抬高型心肌梗死的临床应用价值。

方法

选取2015年12月至2016年12月山西医科大学第一医院心内科，急性胸痛发作3 h内入院且拟行冠脉造影术的患者111例，入院即刻测定血清h-FABP、心肌肌钙蛋白I(cTnI)水平；行超声心动图检查，应用二维斑点追踪技术(2D-STI)测定左心室17节段的圆周应变(CS)，并计算左室整体圆周应变(GCS)。根据冠脉造影结果、入院6 h后血清cTnI结果及心电图表现分为两组，即非ST段抬高型心肌梗死(NSTEMI)组71例、正常对照组40例。

结果

NSTEMI组入院即刻血清cTnI水平(0.58±0.71)μg/L，对照组(0.43±0.63)μg/L，两组比较差异无统计学意义(t＝1.10，P>0.05)。NSTEMI组较对照组入院即刻血清h-FABP水平[(NSTEMI组(5.59±2.76)μg/L，对照组(1.79±2.39)μg/L]、GCS[(NSTEMI组(－15.80±2.33)%，对照组(－18.89±2.50)%]较对照组高，差异有统计学意义(t＝7.30，6.54；P<0.05)。h-FABP早期诊断NSTEMI的受试者工作特征(ROC)曲线下面积为0.851；GCS早期诊断NSTEMI的ROC曲线下面积为0.854；联合h-FABP与GCS早期诊断NSTEMI的ROC曲线下面积为0.916。h-FABP＋GCS联合诊断NSTEMI优于单项检测。

结论

h-FABP联合GCS可提高NSTEMI的早期诊断率。

关键词: 脂肪酸结合蛋白类, 圆周应变, 非ST段抬高型心肌梗死, 诊断

Objective

To explore the clinical application value of heart fatty acid binding protein (h-FABP) combined with echocardiographic circumferential strain on early diagnosis of non ST segment elevation myocardial infarction (NSTEMI).

Methods

A total of 111 patients with acute chest pain within 3 hours who underwent coronary angiography were selected in cardiology of the First Hospital of Shanxi Medical University from December 2015 to December 2016.Serum levels of h-FABP and cardiac troponin I (cTnI) were measured immediately after admission.The left ventricular circumferential strain(CS) of 17 segments was determined by echocardiographic two-dimensional speckle tracking imaging(2D-STI), and the left ventricular global circumferential strain (GCS) was calculated simultaneously.According to the results of coronary angiography, cTnI level 6h after admission and ECG manifestation, patients were divided into 2 groups: 71 cases in NSTEMI group and 40 cases in the normal control group.

Results

The cTnI level of NSTEMI group [(0.58±0.71)μg/L] was higher than that of control group [(0.43±0.63)μg/L], the difference was not statistically significant (t=1.10, P>0.05). The levels of H-FABP [(NSTEMI group: (5.59±2.76)μg/L, control group (1.79±2.39)μg/L], GCS [(NSTEMI group: (-15.80±2.33)%, control group: (-18.89±2.50)%] in NSTEMI group were significantly higher than those in the control group (t=7.30, 6.54; P<0.05). The area under the receiver operating characteristic (ROC) curve of h-FABP in the early diagnosis of NSTEMI was 0.851, the area under the ROC curve of GCS in the early diagnosis of NSTEMI was 0.854, the area under the ROC curve of combining h-FABP with GCS in the early diagnosis of NSTEMI was 0.916.Joint detection of H-FABP+ GCS was better than single detection in the early diagnosis of NSTEMI.

Conclusion

Combining serum level of h-FABP with echocardiographic GCS can improve the early diagnostic rate of NSTEMI.

Key words: Fatty acid-binding proteins, Circumferential strain, Non ST segment elevation myocardial infarction, Diagnosis

表1 两组患者一般情况的比较

组别	例数	年龄(岁，±s)	男性(例，%)	吸烟(例，%)	高血压(例，%)	糖尿病(例，%)	血脂异常(例，%)
NSTEMI组	71	54.6±8.78	44(62.0)	51(71.8)	48(67.6)	43(60.6)	49(69.0)
对照组	40	53.0±7.38	24(60.0)	25(62.5)	29(72.5)	21(52.5)	22(55.0)
统计量	?	t＝0.96	χ²＝0.04	χ²＝1.03	χ²＝0.29	χ²＝0.68	χ²＝2.18
P值	?	0.338	0.842	0.395	0.671	0.430	0.155

表1 两组患者一般情况的比较

组别	例数	年龄(岁，±s)	男性(例，%)	吸烟(例，%)	高血压(例，%)	糖尿病(例，%)	血脂异常(例，%)
NSTEMI组	71	54.6±8.78	44(62.0)	51(71.8)	48(67.6)	43(60.6)	49(69.0)
对照组	40	53.0±7.38	24(60.0)	25(62.5)	29(72.5)	21(52.5)	22(55.0)
统计量	?	t＝0.96	χ²＝0.04	χ²＝1.03	χ²＝0.29	χ²＝0.68	χ²＝2.18
P值	?	0.338	0.842	0.395	0.671	0.430	0.155

表2 两组患者血清cTnI、h-FABP水平及GCS比较(±s)

组别	例数	cTnI(μg/L)	h-FABP(μg/L)	GCS(%)
NSTEMI组	71	0.58±0.71	5.59±2.76	－15.80±2.33
对照组	40	0.43±0.63	1.79±2.39	－18.89±2.50
t值	?	1.10	7.30	6.54
P值	?	0.27	0.00	0.00

表2 两组患者血清cTnI、h-FABP水平及GCS比较(±s)

组别	例数	cTnI(μg/L)	h-FABP(μg/L)	GCS(%)
NSTEMI组	71	0.58±0.71	5.59±2.76	－15.80±2.33
对照组	40	0.43±0.63	1.79±2.39	－18.89±2.50
t值	?	1.10	7.30	6.54
P值	?	0.27	0.00	0.00

图1 心型脂肪酸结合蛋白、左室整体圆周应变单项检测非ST段抬高型心肌梗死ROC曲线

图2 心型脂肪酸结合蛋白、左室整体圆周应变联合检测非ST段抬高型心肌梗死ROC曲线

表3 h-FABP、GCS单项检测与联合检测的AUC95%可信区间及截断点

项目	AUC	标准误	P值	95%可信区间		截断点
项目	AUC	标准误	P值	下限	上限	截断点
h-FABP	0.851	0.041	0.000	0.771	0.930	4.44
GCS	0.854	0.038	0.000	0.779	0.929	－17.69
h-FABP＋GCS	0.916	0.027	0.000	0.863	0.968	?

表3 h-FABP、GCS单项检测与联合检测的AUC95%可信区间及截断点

项目	AUC	标准误	P值	95%可信区间		截断点
项目	AUC	标准误	P值	下限	上限	截断点
h-FABP	0.851	0.041	0.000	0.771	0.930	4.44
GCS	0.854	0.038	0.000	0.779	0.929	－17.69
h-FABP＋GCS	0.916	0.027	0.000	0.863	0.968	?

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Clinical value of serum level of heart fatty acid binding protein and echocardiographic circumferential strain on early diagnosis of non ST segment elevation myocardial infarction

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Clinical value of serum level of heart fatty acid binding protein and echocardiographic circumferential strain on early diagnosis of non ST segment elevation myocardial infarction