CAJ | 학술논문

目的探讨心肌型脂肪酸结合蛋白(heart-type fatty acid-binding protein,H-FABP)在钝性心脏损伤(blunt cardiac injury,BCI)早期诊断中的价值.方法前瞻性研究2007年1月至2008年6月间复旦大学附属上海市第五人民医院收治的42例钝性胸部损伤患者和同期本院健康体检中心42例健康体检者血清心肌标志物水平,采用双抗体夹心酶联免疫一步法定量检测42例健康体检者和42例钝性胸部损伤患者伤后3,6,12 h血清H-FABP、心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTn Ⅰ)和肌红蛋白(Myoglobin,Myo)含量.以cTn Ⅰ作为诊断BCI的金标准,将42例钝性胸部损伤患者分为心肌损伤组(13例)和非心肌损伤组(29例).绘制H-FABP和cTn Ⅰ在胸部损伤患者伤后3,6,12 h诊断BCI的受试者特征曲线(receiver operating characteristic curve,ROC curve),并比较曲线下面积(area under the curve,AUC),分析伤后不同时间(3,6,12 h)血清H-FABP和cTn Ⅰ对BCI的诊断价值.多组均数间的差异性比较采用Kruskal Wallis检验,ROC曲线下面积比较采用delong.clarke-pearson检验.以P＜0.05为差异具有统计学意义.结果伤后3 h诊断BCI的AUCH-FABP和AUCcTnⅠ分别为0.9257和0.6844.AUCH-FABP大于AUCcTnⅠ,二者差异具有统计学意义(P=0.0125),伤后12 h诊断BCI的AUCH-FABP小于AUCcTn Ⅰ,差异具有统计学意义(0.9841 vs.0.8276,P=0.0278),二者对诊断伤后6 h BCI的ROC曲线下面积相比,差异无统计学意义(0.9655 vs.0.9125,P=0.2609).结论 H-FABP对BCI具有早期诊断价值,其伤后3 h的敏感性优于cTnⅠ.
목적 탐토심기형지방산결합단백(heart-type fatty acid-binding protein,H-FABP)재둔성심장손상(blunt cardiac injury,BCI)조기진단중적개치.방법전첨성연구2007년1월지2008년6월간복단대학부속상해시제오인민의원수치적42례둔성흉부손상환자화동기본원건강체검중심42례건강체검자혈청심기표지물수평,채용쌍항체협심매련면역일보법정량검측42례건강체검자화42례둔성흉부손상환자상후3,6,12 h혈청H-FABP、심기기개단백Ⅰ(cardiac troponin Ⅰ,cTn Ⅰ)화기홍단백(Myoglobin,Myo)함량.이cTn Ⅰ작위진단BCI적금표준,장42례둔성흉부손상환자분위심기손상조(13례)화비심기손상조(29례).회제H-FABP화cTn Ⅰ재흉부손상환자상후3,6,12 h진단BCI적수시자특정곡선(receiver operating characteristic curve,ROC curve),병비교곡선하면적(area under the curve,AUC),분석상후불동시간(3,6,12 h)혈청H-FABP화cTn Ⅰ대BCI적진단개치.다조균수간적차이성비교채용Kruskal Wallis검험,ROC곡선하면적비교채용delong.clarke-pearson검험.이P＜0.05위차이구유통계학의의.결과상후3 h진단BCI적AUCH-FABP화AUCcTnⅠ분별위0.9257화0.6844.AUCH-FABP대우AUCcTnⅠ,이자차이구유통계학의의(P=0.0125),상후12 h진단BCI적AUCH-FABP소우AUCcTn Ⅰ,차이구유통계학의의(0.9841 vs.0.8276,P=0.0278),이자대진단상후6 h BCI적ROC곡선하면적상비,차이무통계학의의(0.9655 vs.0.9125,P=0.2609).결론 H-FABP대BCI구유조기진단개치,기상후3 h적민감성우우cTnⅠ.
Objective To study the value of heart-type fatty acid-binding protein(H-FABP)for the early diagnosis of blunt cardiac injury(BCI).Method A prospective stuay was carried out in 42 patients,who suffered from blunt thoracic injury and were admitted from January 2007 to June 2008,and another42 heathy individuals in the health center of the Shanghai Fifth Hospital were recruited as control.Serum H-FABP,cTn Ⅰ and Myo levels of both healthy individuals and petients at 3,6 and 12 hours after trauma were measured by using ELLSA.Serum cTn Ⅰ levels was taken as a golden standard for the diagnosis of BCI.Accroding to serum cTn Ⅰ levels.42 patients with blunt thoracic injury were divided into group of patient with myocardial damage(13 patients)and group of patients without(29 patients).The receiver operating characteristic curves(ROC)of H-FABP and cTn Ⅰ in the diagnosis of BCI drawed at 3,6 and 12 hours after trauma,respectively,and the areas under curve(AUC)of ROC were compared.The values of H-FABP and cTn Ⅰ for diagnosing at 3,6 and 12 hours after trauma were analyzed Differences in serum H-FABP,cTn Ⅰ and Myo concentrations between groups were compared by Kruskal Wallis tegt.The delong.clarkepearson test was used to compare the areas under the ROC curves.Results AUCH-FABP and AUCcTn Ⅰfor diagnosing BCI at 3 hours after trauma were 0.9257 and0.6844,respectively,and AUCH-FABF was significantly more than AUCcTn Ⅰ(P=0.0125).AUCH-FABP,was significantly less than AUCcTnⅠ(0.9841 vs0.8276,P=0.0278)for diagnosing BCI at 12 hours after trauma.There was no significant difference in diagnosing BCI between AUCH-FABp and AUCcTn Ⅰat 12 hours after trauma(0.9655 vs.0.9125,P=0.2609).Conclusions H-FABP is valuabe in the early diagnosis of BCI,and its sensitivity is higherthanthat of cTnⅠ in diagnosing BCI at 3 hours after trauma.