H-FABP和RDW及NT-proBNP水平应用于急性非ST段抬高型心肌梗死诊断的价值分析

李傲航; 田媛媛; 高琰; 张金仿

doi:10.16766/j.cnki.issn.1674-4152.002198

H-FABP和RDW及NT-proBNP水平应用于急性非ST段抬高型心肌梗死诊断的价值分析

doi: 10.16766/j.cnki.issn.1674-4152.002198

首都医科大学附属北京友谊医院临床检验中心，北京 100050

基金项目:

国家自然科学基金项目 81802064

详细信息

通讯作者:
张金仿，E-mail：zhangjin1fang@126.com

中图分类号: R542.22 R446
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- 文章访问数: 122
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- 被引次数: 0
出版历程
- 收稿日期: 2021-01-22
- 网络出版日期: 2022-02-15

Application value of H-FABP, RDW and NT-proBNP levels in the diagnosis of acute non ST segment elevation myocardial infarction

Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

摘要

摘要: 目的探讨心型脂肪酸结合蛋白(H-FABP)、红细胞体积分布宽度(RDW)及末端脑钠肽前体(NT-proBNP)水平应用于急性非ST段抬高型心肌梗死(NSTEMI)诊断的价值，为临床NSTEMI诊断提供参考。方法选择2019年1月—2020年1月首都医科大学附属北京友谊医院急性NSTEMI患者45例作为NSTEMI组，将其按照Gensini积分分为轻度组、中度组及重度组，另选择同期非心源性胸痛、心绞痛患者45例设为非NSTEMI组，健康体检者45例作为对照组。比较各组H-FABP、RDW及NT-proBNP水平差异，分析其单独及联合检测NSTEMI的诊断价值。结果 NSTEMI组患者H-FABP、RDW、NT-proBNP水平均明显高于非NSTEMI组和对照组，且非NSTEMI组明显高于对照组(均P < 0.05)。重度组H-FABP、RDW、NT-proBNP水平明显高于轻度以及中度组，且中度组明显高于轻度组(均P < 0.05)。NSTEMI患者H-FABP、RDW、NT-proBNP水平与Gensini积分呈正相关(均P < 0.05)。H-FABP、RDW、NT-proBNP单独及联合诊断NSTEMI的AUC值分别为0.813、0.758、0.866、0.887。结论血清H-FABP、RDW、NT-proBNP参与急性NSTEMI的发生发展，其水平随急性NSTEMI患者病情加重而逐渐升高，三者联合检测对NSTEMI具有较高诊断价值。
- 心型脂肪酸结合蛋白 /
- 红细胞体积分布宽度 /
- 末端脑钠肽前体 /
- 急性非ST段抬高型心肌梗死 /
- 诊断价值
Abstract: Objective To investigate the application value of heart-type fatty acid binding protein (H-FABP), red blood cell volume distribution width (RDW) and terminal pro brain natriuretic peptide (NT-proBNP) levels in the diagnosis of acute non ST segment elevation myocardial infarction (NSTEMI) and to provide a reference for the clinical diagnosis of NSTEMI. Methods Forty-five patients with acute NSTEMI who were admitted to our hospital from January 2019 to January 2020 were designated as the NSTEMI group, and they were divided into mild, moderate and severe groups according to Gensini score. Forty-five patients with noncardiogenic chest pain and angina pectoris in the same period were designated as non-NSTEMI group. Forty-five healthy people were designated as the control group. The levels of H-FABP, RDW and NT proBNP in each group were compared to analyse the diagnostic value of those in the NSTEMI group. Results The levels of H-FABP, RDW and NT-proBNP in the NSTEMI group were higher than those in the non-NSTEMI and control groups, and the levels of H-FABP, RDW and NT-proBNP in the non-NSTEMI group were apparently higher than those in the control group (all P < 0.05). The levels of H-FABP, RDW and NT-proBNP in the severe NSTEMI group were apparently higher than those in the mild and moderate groups, and the levels of H-FABP, RDW and NT-proBNP in the moderate NSTEMI group were apparently higher than those in the mild group (all P < 0.05). The levels of H-FABP, RDW and NT-proBNP in NSTEMI patients were positively correlated with Gensini score (all P < 0.05). The AUC values of PH-FABP, RDW and NT-proBNP alone and in the combined diagnosis of NSTEMI were 0.813, 0.758, 0.866 and 0.887, respectively. Conclusion Serum ph-FABP, RDW and NT-probNP participate in the occurrence and development of acute NSTEMI, the level of which increased gradually with the aggravation of the illness of patients with acute NSTEMI. The combined detection of ph-FABP, RDW and NT-probNP have a higher diagnostic value for NSTEMI.

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图 1 H-FABP、RDW、NT-proBNP单独及联合诊断NSTEMI的ROC曲线

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表 1 3组研究对象一般资料比较

组别	例数	性别(例)		年龄(x ±s，岁)	体重指数(x ±s)
组别	例数	男性	女性	年龄(x ±s，岁)	体重指数(x ±s)
对照组	45	27	18	58.42±7.06	22.68±1.71
非NSTEMI组	45	24	21	57.64±6.66	22.14±1.75
NSTEMI组	45	26	19	59.36±7.18	22.87±1.73
统计量		0.423^a		0.687^b	2.156^b
P值		0.809		0.505	0.120
注：^a为χ²值，^b为F值。

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表 2 3组H-FABP、RDW及NT-proBNP水平比较(x ±s)

组别	例数	H-FABP(μg/L)	RDW(%)	NT-proBNP(pg/mL)
对照组	45	3.76±0.41	11.97±1.74	31.88±7.32
非NSTEMI组	45	7.52±0.95^a	13.03±2.00^a	375.43±78.61^a
NSTEMI组	45	8.73±1.26^ab	14.81±2.13^ab	723.03±106.13^ab
F值		341.136	24.043	921.441
P值		< 0.001	< 0.001	< 0.001
注：与对照组比较，^aP < 0.05;与非NSTEMI组比较，^bP < 0.05。

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表 3 不同严重程度NSTEMI患者H-FABP、RDW及NT-proBNP水平比较(x ±s)

组别	例数	H-FABP(μg/L)	RDW(%)	NT-proBNP(pg/mL)
轻度组	13	7.80±0.85	13.21±1.44	642.42±57.00
中度组	22	8.76±1.25^a	14.84±1.90^a	719.01±85.75^a
高度组	10	9.89±0.56^ab	16.83±1.55^ab	836.64±94.29^ab
F值		56.857	54.876	66.284
P值		< 0.001	< 0.001	< 0.001
注: 与轻度组比较，^aP < 0.05;与中度组比较，^bP < 0.05。

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表 4 NSTEMI患者H-FABP、RDW及NT-proBNP与Gensini积分相关性分析

指标	Gensini积分
指标	r值	P值
H-FABP	0.533	< 0.001
RDW	0.515	< 0.001
NT-proBNP	0.591	< 0.001

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表 5 H-FABP、RDW及NT-proBNP单独及联合诊断NSTEMI的ROC分析结果

指标	AUC	敏感度	特异度	最佳截断点	95% CI
H-FABP	0.813	0.803	0.716	7.155	0.741~0.884
RDW	0.758	0.525	0.081	14.600	0.675~0.840
NT-proBNP	0.866	0.803	0.797	392.960	0.805~0.927
联合诊断	0.887	0.852	0.824	0.482	0.829~0.944

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参考文献(19)

[1]	耿旭, 张恒, 马宾, 等. Hcy与急性ST段抬高型心肌梗死患者急诊PCI术后无复流的关系及机制[J]. 中华全科医学, 2019, 17(7): 1109-1111, 1177. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201907013.htm
[2]	吴忠璟, 夏可辉, 钟书刚. 血清Copeptin、BNP及cTnI在老年急性ST段抬高型心肌梗死诊断中的价值[J]. 中华全科医学, 2019, 17(8): 1368-1371.
[3]	许海静, 石海红, 刘晓萍, 等. 心脏脂肪酸结合蛋白水平对急性冠脉综合征的早期诊断[J]. 中国老年学杂志, 2019, 39(24): 5918-5920. doi: 10.3969/j.issn.1005-9202.2019.24.005
[4]	江冠颖, 赵玉兰, 董静, 等. 左心室射血分数正常的急性ST段抬高型心肌梗死患者氨基末端B型利钠肽原水平与冠状动脉病变的关系[J]. 中国循环杂志, 2017, 32(2): 137-140. doi: 10.3969/j.issn.1000-3614.2017.02.006
[5]	赵映璇, 赵玉兰, 黄亚萍, 等. 急性ST段抬高型心肌梗死患者红细胞分布宽度与左心室收缩功能不全的关系[J]. 实用医学杂志, 2018, 34(24): 4080-4083. doi: 10.3969/j.issn.1006-5725.2018.24.016
[6]	徐峥嵘, 文立生, 庄德贞, 等. BNP、hs-CRP水平早期鉴别诊断NSTEMI的临床价值[J]. 中西医结合心脑血管病杂志, 2019, 17(12): 1909-1912. doi: 10.12102/j.issn.1672-1349.2019.12.043
[7]	彭毅, 陈晓玲, 杨徐. 碎裂QRS波群对老年非ST段抬高性心肌梗死患者临床诊断及冠状动脉病变程度的预测价值[J]. 中国急救医学, 2018, 38(2): 133-137. doi: 10.3969/j.issn.1002-1949.2018.02.009
[8]	孔俊虹, 张琪. 脉通口服液对急性冠脉综合征经皮冠状动脉介入术后患者运动耐量及Hcy的影响[J]. 中药材, 2018, 41(10): 2446-2450. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYCA201810041.htm
[9]	刘红军, 杨杰. 平均血小板体积联合Gensini评分预测ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术近期预后[J]. 中国介入影像与治疗学, 2019, 16(3): 139-143. https://www.cnki.com.cn/Article/CJFDTOTAL-JRYX201903005.htm
[10]	HEDAYATI T, YADAV N, KHANAGAVI J. Non-ST-segment acute coronary syndromes[J]. Cardiol Clin, 2018, 36(1): 37-52. doi: 10.1016/j.ccl.2017.08.003
[11]	BIVONA G, AGNELLO L, BELLIA C, et al. Diagnostic and prognostic value of H-FABP in acute coronary syndrome: Still evidence to bring[J]. Clin Biochem, 2018, 6(58): 1-4. http://www.ncbi.nlm.nih.gov/pubmed/29698621
[12]	邓凤珠, 李春富, 符海燕, 等. 心型脂肪酸结合蛋白和红细胞体积分布宽度及心肌肌钙蛋白T联合检测对急性非ST段抬高型心肌梗死的早期诊断价值[J]. 中国医药, 2020, 15(4): 499-503. doi: 10.3760/j.issn.1673-4777.2020.04.005
[13]	卢振峰, 倪海滨, 孔维敏, 等. 正常心肌标志物对早期非ST段抬高性心肌梗死的诊断价值[J]. 中华急诊医学杂志, 2020, 29(3): 413-416. doi: 10.3760/cma.j.issn.1671-0282.2020.03.021
[14]	王艳飞, 赵春生, 于健, 等. 红细胞分布宽度与修正休克指数对非ST段抬高型心肌梗死预后的关系研究[J]. 河北医药, 2019, 41(16): 2494-2496, 2500. doi: 10.3969/j.issn.1002-7386.2019.16.024
[15]	HAO Y J, SUN H B, LI H W, et al. Application of positive behavior management in patients after breast cancer surgery[J]. World J Clin Cases, 2020, 8(4): 689-699. doi: 10.12998/wjcc.v8.i4.689
[16]	XU X X, JIA R Y, WANG T. Relation between red cell distribution width and severity of coronary artery disease[J]. Chi HEART J, 2017, 29(1): 69-71.
[17]	ZHAO X Y, LI J X, TANG X F, et al. Prognostic value of NT-proBNP in stable coronary artery disease in Chinese patients after percutaneous coronary intervention in the drug-eluting stent era[J]. Biomed Environ Sci, 2018, 31(12): 859-866. http://www.ncbi.nlm.nih.gov/pubmed/30636655
[18]	张坚, 王海明, 孙晓斐. 瑞舒伐他汀对急性冠脉综合征合并心力衰竭病人NT-proBNP及炎症因子的影响[J]. 中西医结合心脑血管病杂志, 2019, 17(7): 1046-1048. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY201907025.htm
[19]	闫小菊, 李勇, 张羽, 等. 血清Hcy、NT-proBNP及脂联素与老年冠心病冠状动脉病变的相关性[J]. 中国老年学杂志, 2020, 40(4): 673-678. doi: 10.3969/j.issn.1005-9202.2020.04.001