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目的探讨联合检测心型脂肪酸结合蛋白和同型半胱氨酸对急性心肌梗死早期(发病6 h内)诊断的临床意义。方法选择胸痛6 h内入院被确诊为AMI的患者138例为实验组,根据患者冠脉造影结果分为实验A组(单支血管病变)、实验B组(双支血管病变)和实验C组(3支及以上血管病变)3个小组,另外选择同期健康体检者40例组成对照组,分别测定H-FABP和Hcy的浓度水平,对结果进行综合分析。结果实验组及各小组患者的H-FABP和Hcy的浓度水平均明显高于对照组,差异具有统计学意义(P<0.05);随着血管病变支数的增加,实验组患者的H-FABP和Hcy的浓度水平呈现逐渐升高的趋势,各小组间两项指标两两比较,差异均具有统计学意义(P<0.05)。H-FABP和Hcy的特异度均超过90.00%,敏感度也超过85.00%,联合检测敏感度明显高于单项检测结果,差异均具有统计学意义(P<0.05),但特异度有所降低。结合Youden指数、阴阳性似然比和阴阳性预测值可见,对于AMI疾病的早期诊断价值,联合检测>H-FABP>Hcy。结论 H-FABP和Hcy均为辅助早期诊断AMI疾病的有效指标,随着血管病变支数的增加,其浓度水平逐渐升高,对于疾病的监测具有一定的临床价值,联合检测两项的诊断价值明显,值得临床推广。
Objective To investigate the clinical significance of combined detection of cardiac fatty acid binding protein and homocysteine in the diagnosis of acute myocardial infarction (within 6 h). Methods One hundred and thirteen patients with AMI who were admitted to hospital within 6 hours after chest pain were selected as experimental group and divided into experimental group A (single vessel disease), experimental group B (double vessel disease) and experimental group C according to the results of coronary angiography. (3 or more vascular lesions) in the three groups. In addition, 40 healthy subjects of the same period were selected as the control group, and the concentrations of H-FABP and Hcy were determined respectively. The results were analyzed comprehensively. Results The concentrations of H-FABP and Hcy in experimental group and each group were significantly higher than those in control group (P <0.05). With the increase of vascular lesion count, H-FABP (P <0.05). There was a significant difference between the two indexes in every group (P <0.05). The specificity of H-FABP and Hcy were more than 90.00% and the sensitivity was over 85.00%. The sensitivity of combined detection was significantly higher than that of single test, the difference was statistically significant (P <0.05), but the specificity was lower. According to the Youden index, the positive and negative likelihood ratio and the positive and negative predictive value were visible. For the early diagnosis value of AMI disease, the combined detection> H-FABP> Hcy. Conclusions Both H-FABP and Hcy are effective indicators for early diagnosis of AMI. As the number of vascular lesions increases, the concentration of H-FABP and Hcy gradually increases, which has certain clinical value for disease monitoring. The diagnostic value of the two tests Obviously, it is worth clinical promotion.