• 南方醫(yī)科大學(xué)南方醫(yī)院（廣州 510515）;

目的 　系統(tǒng)評價心肌脂肪酸結(jié)合蛋白（H-FABP）早期診斷急性心肌梗死（acute myocardial infarction, AMI）的診斷價值。
方法 　檢索MEDLINE、EMbase 和中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫、維普中文科技期刊數(shù)據(jù)庫、中國學(xué)術(shù)會議論文庫，檢索時間截至2006年11月，手檢1980～2006年10月國內(nèi)相關(guān)雜志16種。按照文內(nèi)所述納入標準共收集到H-FABP早期診斷AMI的研究，采用QUADAS工具進行質(zhì)量評價，按胸痛發(fā)作距離采血時間設(shè)定4個時間組，分別納入相應(yīng)研究，利用Metadisc軟件進行異質(zhì)性分析及Meta分析，繪制SROC曲線。
結(jié)果 　共納入13個研究（n=1 739）。13個研究結(jié)果存在異質(zhì)性（P=0, I2=58.5%）?；颊咝赝窗l(fā)作0～3 h 組納入5個研究（n=396），各研究間無異質(zhì)性（P=0.49, I2=0），合并敏感度0.86 [95%CI（0.80, 0.91）]，合并特異度0.76 [95%CI（0.80，0.91）]，SROC曲線下面積0.88，SE=0.0323?；颊咝赝窗l(fā)作0～6 h組納入10個研究（n=1 175），各研究間存在異質(zhì)性（P=0，I2=69%），合并敏感度0.86 [95%CI（0.83，0.89）]，合并特異度0.79 [95%CI （0.76，0.82）]，SROC曲線下面積0.92，SE=0.019?；颊咝赝窗l(fā)作6～12 h組納入4個研究（n=215），各研究間無異質(zhì)性（P=0.56，I2=0），合并敏感度0.97 [95%CI（0.91，0.99）]，合并特異度0.52 [95%CI（0.42，0.61）]，SROC曲線下面積0.810，SE=0.152 2?；颊咝赝窗l(fā)作0～12 h組納入11個研究（n=1 352），各研究間有異質(zhì)性（P=0.56，I2=59%），合并敏感度0.88 [95%CI（0.84，0.89）]，合并特異度0.75 [95%CI（0.71，0.78）]，SROC曲線下面積0.91，SE=0.016 4。
結(jié)論 　從目前研究看， H-FABP在患者胸痛發(fā)作后0～3 h已經(jīng)顯示出較好的診斷效能，在胸痛發(fā)作0～12 h內(nèi)均具有較好的診斷效能。 H-FABP可以作為AMI早期篩查及診斷新指標。

引用本文： 劉杰,王前,耿仁文,曾方銀,張鵬. 心肌脂肪酸結(jié)合蛋白對急性心肌梗死早期診斷價值的系統(tǒng)評價. 中國循證醫(yī)學(xué)雜志, 2007, 07(4): 251-259. doi: 復(fù)制

1. Chen LL, Yang F, Guo XM, et al. Heart-type fatty acid-binding protein in the diagnosis of acute myocardial infarction at early stage. Chinese Journal of Emergency Medicine, 2005, 14(11): 934-937.
2. Chen LL, Xie HY, Yang F, et al. The role of heart-type fatty acid-binding protein in the diagnosis of acute myocardial infarction within early stage. Journal of Clinical Cardiology, 2005, 21(7): 400-403.
3. Chen L, Guo X, Yang F. Role of heart-type fatty acid binding protein in early detection of acute myocardial infarction in comparison with cTnI, CK-MB and myoglobin. J Huazhong Univ Sci Technolog Med Sci, 2004, 24(5): 449-451, 459.
4. Zhang P, Zheng L, Zeng FY. A Comparison of different combination regimens of biochemical markers in diagnosing acute myocardial infarction.Chinese Journal of Evidence-Based, 2006, 6(11): 777-782.
5. Yi ZY, Li XY, Sun Y, et al. ROC curve estimates the value of heart-type fatty acid-binding protein for early detection of acute myocardial infarction. Chinese Journal of Laboratory Medicine, 2004, 27(6): 375-377.
6. Liu GJ, Wu TX. Summary ROC curve-diagnostic test method of meta-analysis. Chinese Journal of Evidence-Based Medicine, 2003, 3(1): 41-44.
7. Rajappa M, Sharma A. Biomarkers of cardiac injury: an update. Angiology JT, 2005, 56(6): 677-691.
8. Yang Z, Zhou D. Cardiac markers and their point-of-care testing for diagnosis of acute myocardial infarction. Clin Biochem JT, 2006, 39(8): 771-780.
9. Azzazy HM, Pelsers MM, Christenson RH. Unbound free fatty acids and heart-type fatty acid-binding protein: diagnostic assays and clinical applications. Clin Chem JT, 2006, 52(1): 19-29.
10. Alhadi HA, Fox KA. Do we need additional markers of myocyte necrosis: the potential value of heart fatty-acid-binding protein. QJM, 2004, 97(4): 187-198.
11. Myocardial infarction redefined: a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J JT, 2000, 21(18): 1502-1513.
12. Whiting P, Rutjes AWS, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology, 2003, 3:25.
13. Zamora J, Abraira V, Muriel A, et al. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Medical Research Methodology, 2006, 6(1):31.
14. 陳莉莉, 楊霏, 郭小梅, 等. 快速檢測心肌脂肪酸結(jié)合蛋白診斷早期急性心肌梗死. 中華急診醫(yī)學(xué)雜志, 2005,14(11): 934-937.
15. 陳莉莉, 謝紅艷, 楊霏,等. 心肌脂肪酸結(jié)合蛋白對早期急性心肌梗死的診斷. 臨床心血管病雜志, 2005,21(7): 400-403.
16. Ohkary Y, Tanaka T, Kitaura Y, et al. Point-of-care testing of H-FABP for the diagnosis of acute myocardial infarction: comparison with conventional tests for myoglobin, CK-MB and troponin T. Clin Chem, 2001, 47(3): A194.
17. Ghani F, Wu AHB, Graff L, et al. Role of heart-type fatty acid-binding protein in early detection of acute myocardial infarction. Clinical Chemistry, 2000, 46(5): 718-719.
18. Glatz JFC, Van Der Vusse, GJ, Simoons ML, et al. Fatty acid-binding protein and the early detection of acute myocardial infarction. Clinica Chimica Acta, 1998, 272(1): 87-92.
19. Alansari SE, Croal BL. Diagnostic value of heart fatty acid binding protein and myoglobin in patients admitted with chest pain. Ann Clin Biochem., 2004, 41(Pt5): 391-396.
20. Alhashemi JA. Diagnostic accuracy of a bedside qualitative immunochromatographic test for acute myocardial infarction. Am J Emerg Med JT, 2006, 24(2): 149-155.
21. Seino Y, Ogata K, Takano T, et al. Use of a whole blood rapid panel test for heart-type fatty acid-binding protein in patients with acute chest pain: comparison with rapid troponin T and myoglobin tests. Am J Med., 2003, 115(3): 185-190.
22. Seino Y, Tomita Y, Takano T, et al. Office cardiologists cooperative study on whole blood rapid panel tests in patients with suspicious acute myocardial infarction: comparison between heart-type fatty acid-binding protein and troponin t tests. Circ J., 2004, 68: 144-148.
23. Nakata T, Hashimoto A, Hase M, et al. Human heart-type fatty acid-binding protein as an early diagnostic and prognostic marker in acute coronary syndrome. Cardiology, 2003, 99(2): 96-104.
24. Pagani F, Bonora R, Bonetti G, et al. Evaluation of a sandwich enzyme-linked immunosorbent assay for the measurement of serum heart fatty acid-binding protein. Ann Clin Biochem JT, 2002, 39(Pt 4): 404-405.
25. Okamoto F, Sohmiya K, Ohkaru Y, et al. Human heart-type cytoplasmic fatty acid-binding protein (H-FABP) for the diagnosis of acute myocardial infarction. Clinical evaluation of H-FABP in comparison with myoglobin and creatine kinase isoenzyme MB. Clin Chem Lab Med., 2000, 38(3): 231-238.
26. Haastrup B, Gill S, Kristensen SR, et al. Biochemical markers of ischaemia for the early identification of acute myocardial infarction without St segment elevation. Cardiology JT, 2000, 94(4): 254-261.
27. Ishii J, Wang J, Naruse H, et al. Serum concentrations of myoglobin vs human heart-type cytoplasmic fatty acid-binding protein in early detection of acute myocardial infarction. Clin Chem., 1997, 43 (8 Pt 1): 1372-1378.
28. Tsuji R, Tanaka T, Sohmiya K, et al. Human heart-type cytoplasmic fatty acid-binding protein in serum and urine during hyperacute myocardial infarction. Int J Cardiol, 1993,41(3): 209-217.
29. Tanaka T, Sohmiya K, Kitaura Y, et al. Clinical evaluation of point-of-care-testing of heart-type fatty acid-binding protein (H-FABP) for the diagnosis of acute myocardial infarction. J Immunoassay Immunochem, 2006, 27(3): 225-238.
30. 陳莉莉, 郭小梅, 楊霏. 心肌脂肪酸結(jié)合蛋白對早期急性心肌梗死的診斷：與cTnI, CK-MB ，myo對照研究.華中科技大學(xué)學(xué)報(醫(yī)學(xué)英德文版), 2004, 24(5): 449-451, 459.
31. 張鵬, 鄭磊, 曾方銀, 等. 急性心肌梗死診斷中不同心肌標損傷標志物聯(lián)合應(yīng)用方案的比較. 中國循證醫(yī)學(xué)雜志, 2006,6(11): 777-782.
32. 衣志勇, 李小鷹, 孫宇,等. 受試者特征曲線評價心肌型脂肪酸結(jié)合蛋白在急性心肌梗死早期診斷中的價值.中華檢驗醫(yī)學(xué)雜志, 2004, 27(6): 375-377.
33. 劉關(guān)鍵，吳泰相. 診斷性試驗的Meta分析-SROC曲線法介紹. 中國循證醫(yī)學(xué)雜志，2003，3(1): 41-44.
34. Whiting P, Westwood M, Watt I, et al. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr, 2005, 5(1): 4.
35. Chan CP, Sum KW, Cheung KY, et al. Development of a quantitative lateral-flow assay for rapid detection of fatty acid-binding protein. J Immunol Methods, 2003, 279(1-2): 91-100.
  1. 1. Chen LL, Yang F, Guo XM, et al. Heart-type fatty acid-binding protein in the diagnosis of acute myocardial infarction at early stage. Chinese Journal of Emergency Medicine, 2005, 14(11): 934-937.
  2. 2. Chen LL, Xie HY, Yang F, et al. The role of heart-type fatty acid-binding protein in the diagnosis of acute myocardial infarction within early stage. Journal of Clinical Cardiology, 2005, 21(7): 400-403.
  3. 3. Chen L, Guo X, Yang F. Role of heart-type fatty acid binding protein in early detection of acute myocardial infarction in comparison with cTnI, CK-MB and myoglobin. J Huazhong Univ Sci Technolog Med Sci, 2004, 24(5): 449-451, 459.
  4. 4. Zhang P, Zheng L, Zeng FY. A Comparison of different combination regimens of biochemical markers in diagnosing acute myocardial infarction.Chinese Journal of Evidence-Based, 2006, 6(11): 777-782.
  5. 5. Yi ZY, Li XY, Sun Y, et al. ROC curve estimates the value of heart-type fatty acid-binding protein for early detection of acute myocardial infarction. Chinese Journal of Laboratory Medicine, 2004, 27(6): 375-377.
  6. 6. Liu GJ, Wu TX. Summary ROC curve-diagnostic test method of meta-analysis. Chinese Journal of Evidence-Based Medicine, 2003, 3(1): 41-44.
  7. 7. Rajappa M, Sharma A. Biomarkers of cardiac injury: an update. Angiology JT, 2005, 56(6): 677-691.
  8. 8. Yang Z, Zhou D. Cardiac markers and their point-of-care testing for diagnosis of acute myocardial infarction. Clin Biochem JT, 2006, 39(8): 771-780.
  9. 9. Azzazy HM, Pelsers MM, Christenson RH. Unbound free fatty acids and heart-type fatty acid-binding protein: diagnostic assays and clinical applications. Clin Chem JT, 2006, 52(1): 19-29.
  10. 10. Alhadi HA, Fox KA. Do we need additional markers of myocyte necrosis: the potential value of heart fatty-acid-binding protein. QJM, 2004, 97(4): 187-198.
  11. 11. Myocardial infarction redefined: a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J JT, 2000, 21(18): 1502-1513.
  12. 12. Whiting P, Rutjes AWS, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology, 2003, 3:25.
  13. 13. Zamora J, Abraira V, Muriel A, et al. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Medical Research Methodology, 2006, 6(1):31.
  14. 14. 陳莉莉, 楊霏, 郭小梅, 等. 快速檢測心肌脂肪酸結(jié)合蛋白診斷早期急性心肌梗死. 中華急診醫(yī)學(xué)雜志, 2005,14(11): 934-937.
  15. 15. 陳莉莉, 謝紅艷, 楊霏,等. 心肌脂肪酸結(jié)合蛋白對早期急性心肌梗死的診斷. 臨床心血管病雜志, 2005,21(7): 400-403.
  16. 16. Ohkary Y, Tanaka T, Kitaura Y, et al. Point-of-care testing of H-FABP for the diagnosis of acute myocardial infarction: comparison with conventional tests for myoglobin, CK-MB and troponin T. Clin Chem, 2001, 47(3): A194.
  17. 17. Ghani F, Wu AHB, Graff L, et al. Role of heart-type fatty acid-binding protein in early detection of acute myocardial infarction. Clinical Chemistry, 2000, 46(5): 718-719.
  18. 18. Glatz JFC, Van Der Vusse, GJ, Simoons ML, et al. Fatty acid-binding protein and the early detection of acute myocardial infarction. Clinica Chimica Acta, 1998, 272(1): 87-92.
  19. 19. Alansari SE, Croal BL. Diagnostic value of heart fatty acid binding protein and myoglobin in patients admitted with chest pain. Ann Clin Biochem., 2004, 41(Pt5): 391-396.
  20. 20. Alhashemi JA. Diagnostic accuracy of a bedside qualitative immunochromatographic test for acute myocardial infarction. Am J Emerg Med JT, 2006, 24(2): 149-155.
  21. 21. Seino Y, Ogata K, Takano T, et al. Use of a whole blood rapid panel test for heart-type fatty acid-binding protein in patients with acute chest pain: comparison with rapid troponin T and myoglobin tests. Am J Med., 2003, 115(3): 185-190.
  22. 22. Seino Y, Tomita Y, Takano T, et al. Office cardiologists cooperative study on whole blood rapid panel tests in patients with suspicious acute myocardial infarction: comparison between heart-type fatty acid-binding protein and troponin t tests. Circ J., 2004, 68: 144-148.
  23. 23. Nakata T, Hashimoto A, Hase M, et al. Human heart-type fatty acid-binding protein as an early diagnostic and prognostic marker in acute coronary syndrome. Cardiology, 2003, 99(2): 96-104.
  24. 24. Pagani F, Bonora R, Bonetti G, et al. Evaluation of a sandwich enzyme-linked immunosorbent assay for the measurement of serum heart fatty acid-binding protein. Ann Clin Biochem JT, 2002, 39(Pt 4): 404-405.
  25. 25. Okamoto F, Sohmiya K, Ohkaru Y, et al. Human heart-type cytoplasmic fatty acid-binding protein (H-FABP) for the diagnosis of acute myocardial infarction. Clinical evaluation of H-FABP in comparison with myoglobin and creatine kinase isoenzyme MB. Clin Chem Lab Med., 2000, 38(3): 231-238.
  26. 26. Haastrup B, Gill S, Kristensen SR, et al. Biochemical markers of ischaemia for the early identification of acute myocardial infarction without St segment elevation. Cardiology JT, 2000, 94(4): 254-261.
  27. 27. Ishii J, Wang J, Naruse H, et al. Serum concentrations of myoglobin vs human heart-type cytoplasmic fatty acid-binding protein in early detection of acute myocardial infarction. Clin Chem., 1997, 43 (8 Pt 1): 1372-1378.
  28. 28. Tsuji R, Tanaka T, Sohmiya K, et al. Human heart-type cytoplasmic fatty acid-binding protein in serum and urine during hyperacute myocardial infarction. Int J Cardiol, 1993,41(3): 209-217.
  29. 29. Tanaka T, Sohmiya K, Kitaura Y, et al. Clinical evaluation of point-of-care-testing of heart-type fatty acid-binding protein (H-FABP) for the diagnosis of acute myocardial infarction. J Immunoassay Immunochem, 2006, 27(3): 225-238.
  30. 30. 陳莉莉, 郭小梅, 楊霏. 心肌脂肪酸結(jié)合蛋白對早期急性心肌梗死的診斷：與cTnI, CK-MB ，myo對照研究.華中科技大學(xué)學(xué)報(醫(yī)學(xué)英德文版), 2004, 24(5): 449-451, 459.
  31. 31. 張鵬, 鄭磊, 曾方銀, 等. 急性心肌梗死診斷中不同心肌標損傷標志物聯(lián)合應(yīng)用方案的比較. 中國循證醫(yī)學(xué)雜志, 2006,6(11): 777-782.
  32. 32. 衣志勇, 李小鷹, 孫宇,等. 受試者特征曲線評價心肌型脂肪酸結(jié)合蛋白在急性心肌梗死早期診斷中的價值.中華檢驗醫(yī)學(xué)雜志, 2004, 27(6): 375-377.
  33. 33. 劉關(guān)鍵，吳泰相. 診斷性試驗的Meta分析-SROC曲線法介紹. 中國循證醫(yī)學(xué)雜志，2003，3(1): 41-44.
  34. 34. Whiting P, Westwood M, Watt I, et al. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr, 2005, 5(1): 4.
  35. 35. Chan CP, Sum KW, Cheung KY, et al. Development of a quantitative lateral-flow assay for rapid detection of fatty acid-binding protein. J Immunol Methods, 2003, 279(1-2): 91-100.