缺血性修饰白蛋白、心型脂肪酸结合蛋白、可溶性生长刺激表达基因2蛋白与GRACE评分联合检测对急性冠状动脉综合征的早期诊断价值

doi:10.3877/cma.j.issn.2095-5820.2023.01.003

目的

探讨缺血性修饰白蛋白（IMA）、心型脂肪酸结合蛋白（H-FABP）、可溶性生长刺激表达基因2蛋白（sST2）与全球急性冠状动脉事件注册（GRACE）评分联合检测对急性冠状动脉综合征（ACS）的早期诊断价值。

方法

本研究纳入2021年7月至2022年2月接受治疗的100例ACS患者（观察组）和同期100例健康体检者（对照组），采用乳胶增强免疫比浊法检测血清IMA和H-FABP浓度，采用免疫荧光干式定量法测定血清sST2浓度，利用全球急性冠状动脉事件注册（GRACE）风险评分危险分层将观察组患者分为低危组、中危组和高危组，对比3组患者血清IMA、H-FABP及sST2水平，分析3种检测指标与GRACE评分的关系。通过制作受试者工作特征曲线（ROC），评价各种检测指标的特异性和敏感度，分析3种检测指标及联合检测与GRACE评分用于ACS早期诊断的价值。

结果

观察组患者血清IMA、H-FABP及sST2水平均高于对照组（均P＜0.05）。3组血清IMA及sST2水平比较，差异无统计学意义（P＞0.05），而低危组与高危组H-FABP水平比较，差异有统计学意义（P＜0.05）。相关性分析显示，血清IMA、H-FABP及sST2水平与GRACE评分呈无相关（r=-0.028，P=0.785；r=-0.011，P=0.910；r=-0.046，P=0.65）。ROC曲线显示，IMA、H-FABP及sST2具有较好的特异性（89%~96%），但只有一般的敏感性（54%~76%）。而三者联合检测具有较好的辅助诊断ACS效能（AUC为0.962，敏感度性92%，特异性为94%），高于各项指标单独检测。

结论

早期ACS患者血清IMA、H-FABP、sST2水平呈异常升高状态，且三者与GRACE评分呈无相关。但同时联合三者进行诊断能够提高ACS的诊断效能，对ACS患者的早期诊断具有一定意义。

关键词: 缺血性修饰白蛋白, 心型脂肪酸结合蛋白, 可溶性生长刺激表达基因2蛋白, 急性冠状动脉综合征, 全球急性冠状动脉事件注册评分

Objective

To explore the early diagnostic value of ischemic modified albumin (IMA), heart-type fatty acid binding protein (H-FABP), soluble growth stimulation expression gene 2 protein (sST2) and GRACE score for acute coronary syndrome (ACS).

Methods

One hundred patients with ACS treated from July 2021 to February 2022 were enrolled in this study. Serum IMA and H-FABP concentrations were measured by latex-enhanced immunodeficiency, and serum sST2 concentration was measured by immunofluorescence dry quantification. The levels of serum IMA, H-FABP and sST2 in the three groups were compared, and the patients were divided into low-risk group, medium-risk group and high-risk group according to the risk stratification of the Global Registry of Acute Coronary Events (GRACE). The relationship between GRACE score and the three indicators was analyzed. The receiver operating characteristic curve (ROC) was used to evaluate the specificity and sensitivity of each index, and to analyze the relationship between the three indexes and ACS.

Results

The serum levels of IMA, H-FABP and sST2 in the observation group were significantly higher than those in the control group (P＜0.05). There was no significant difference in serum IMA, H-FABP and sST2 levels were compared among three groups, and it was elevated in the low-risk state. Correlation analysis showed that serum IMA, H-FABP and sST2 levels were not correlated with GRACE score (r=-0.028, P=0.785; r=-0.011, P=0.910; r=-0.046, P=0.65). The ROC curve showed that IMA, H-FABP and sST2 had good specificity (89%~96%), but only general sensitivity (54%~76%). The combined detection of the three indexes had a better auxiliary diagnostic efficacy for ACS (AUC=0.962, sensitivity=92%, specificity=94%), which was significantly higher than the individual detection of each index.

Conclusions

The serum levels of IMA, H-FABP and sST2 are abnormally elevated in patients with early ACS, and they are not correlated with GRACE score. However, the combination of the three methods can improve the diagnostic efficiency of ACS, and has certain significance for the early diagnosis of ACS patients.

Key words: IMA, H-FABP, sST2, acute coronary syndrome, GRACE grade

表1 GRACE风险评分标准

项目	评分	项目	评分
年龄/岁		肌酐/（mg/dl）
＜39	0	0~0.39	1
≤40~49	18	0.4~0.79	3
≤50~59	36	0.8~1.19	5
≤60~69	55	1.2~1.59	7
≤70~79	73	1.2~1.59	9
≤80~89	91	2.0~3.99	15
≥90	100	≥4	20
心率/bpm		危险因素
＜50	0	充血性心力衰竭病史	24
50~69	3	住院期间未行PCI	14
70~89	9	心肌梗死既往史	12
90~109	14	ST段压低	11
110~149	23	心肌损伤标志物增高	15
150~199	35
≥200	43
收缩压/mmHg
＜80	24
80~99	22
100~119	18
120~139	14
140~159	10
160~199	4
≥200	0

表1 GRACE风险评分标准

项目	评分	项目	评分
年龄/岁		肌酐/（mg/dl）
＜39	0	0~0.39	1
≤40~49	18	0.4~0.79	3
≤50~59	36	0.8~1.19	5
≤60~69	55	1.2~1.59	7
≤70~79	73	1.2~1.59	9
≤80~89	91	2.0~3.99	15
≥90	100	≥4	20
心率/bpm		危险因素
＜50	0	充血性心力衰竭病史	24
50~69	3	住院期间未行PCI	14
70~89	9	心肌梗死既往史	12
90~109	14	ST段压低	11
110~149	23	心肌损伤标志物增高	15
150~199	35
≥200	43
收缩压/mmHg
＜80	24
80~99	22
100~119	18
120~139	14
140~159	10
160~199	4
≥200	0

表2 两组血清IMA、H-FABP及sST2水平比较

组别	例数	IMA	H-FABP	sST2
观察组	100	56.00	8.60	18.40
对照组	100	50.05	2.10	8.90
Z值		-6.909	-10.677	-6.933
P值		＜0.001	＜0.001	＜0.001

表2 两组血清IMA、H-FABP及sST2水平比较

组别	例数	IMA	H-FABP	sST2
观察组	100	56.00	8.60	18.40
对照组	100	50.05	2.10	8.90
Z值		-6.909	-10.677	-6.933
P值		＜0.001	＜0.001	＜0.001

表3 3组血清IMA、H-FABP及ST2水平比较

组别	例数	IMA	H-FABP	sST2
低危组	29	56.00	3.10^a	15.30
中危组	29	57.00	6.10	15.20
高危组	42	56.50	9.90	23.40
H值		0.388	4.235	2.009
P值		0.824	0.120	0.366

表3 3组血清IMA、H-FABP及ST2水平比较

组别	例数	IMA	H-FABP	sST2
低危组	29	56.00	3.10^a	15.30
中危组	29	57.00	6.10	15.20
高危组	42	56.50	9.90	23.40
H值		0.388	4.235	2.009
P值		0.824	0.120	0.366

图1 血清IMA、H-FABP及sST2水平与GRACE评分的相关性分析注：1A. IMA水平与GRACE评分相关性散点图；1B. H-FABP水平与GRACE评分相关性散点图；1C. sST2水平与GRACE评分相关性散点图。

图2 血清IMA、H-FABP、sST2及联合检测ACS的ROC曲线

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The combined value of IMA, H-FABP, soluble ST2 and GRACE score in the early diagnosis of acute coronary syndrome

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The combined value of IMA, H-FABP, soluble ST2 and GRACE score in the early diagnosis of acute coronary syndrome