Value of cMyBP-C in Clinical Diagnosis of Acute Myocardial Infarction
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摘要:
目的 通过检测急性心肌梗死患者静脉血中心肌肌球蛋白结合蛋白C（cardiac myosin binding protein-C，cMyBP-C）的浓度，探讨该蛋白作为新型心肌梗死标志物的潜力。 方法 收集以胸痛为首发症状、胸痛发作24 h以内的患者共120例，分为3组，其中急性心肌梗死组40例（A组），心绞痛组20例（B组），非心源性胸痛组60例（C组）；选取体检健康的志愿者30例（D组）作为对照组。所有胸痛患者入院后立即抽取肘静脉血、入院后3 h再次抽血，对照组入组后立即抽取一次静脉血，采用ELISA法、化学发光法分别测定各样本中cMyBP-C和cTnI浓度。 结果 （1）A组cMyBP-C和cTnI浓度明显高于B、C、D组 （P < 0.05）；（2）A组中有9例患者发病时间 < 4 h，入院后立即抽血测得cMyBP-C浓度明显高于D组浓度 （P < 0.05），入院后立即抽血测得cTnI浓度未见明显升高；A组中有35名患者入院后立即行急诊PCI术，术后（入院后3 h） 测得cMyBP-C浓度明显低于术前浓度，术后cTnI浓度较术前升高 （P < 0.05）；（3）A、B、C组中cMyBP-C和cTnI浓度存在正相关关系，cMyBP-C诊断发病时间在24 h以内的急性心肌梗死的ROC曲线AUC值为0.954，灵敏度为92.5%，特异度为90.0%。 结论 cMyBP-C与cTnI类似，有作为早期诊断心肌梗死的生物标志物的潜力，有作为PCI术后病情、手术效果的早期评价指标的潜力。 -
关键词:
- 心肌肌球蛋白结合蛋白C /
- 肌钙蛋白I /
- 急性心肌梗死 /
- 生物标志物
Abstract:Objective To investigate the potential of cardiac myosin binding protein-C （cMyBP-C） as a novel marker of myocardial infarction by detecting the concentration of cardiac myosin binding protein-C （cMyBP-C） in venous blood of patients with acute myocardial infarction. Methods A total of 120 patients with chest pain as the first symptom and within 24 hours of the onset of chest pain were collected and divided into three groups, including 40 patients with acute myocardial infarction （group A）, 20 patients with angina pectoris （group B）, and 60 patients with non-cardiogenic chest pain （Group C）; 30 healthy volunteers （Group D） were selected as the control group. All patients with chest pain were immediately drawn elbow venous blood after admission, and 3 hours after admission. The control group was immediately drawn venous blood once after admission. The concentrations of cMyBP-C and cTnI in each sample were measured by ELISA and chemiluminescence. Results （1） The concentrations of cMyBP-C and cTnI in group A were significantly higher than those in groups B, C and D （P < 0.05）; （2） In group A, the onset time of 9 patients was less than 4h. The concentration of cMyBP-C measured by blood sampling immediately after admission was significantly higher than that in Group D. the concentration of cTnI measured by blood sampling immediately after admission did not increase significantly, and the difference was statistically significant （P < 0.05）; In group A, 35 patients underwent emergency PCI immediately after admission. The concentration of cMyBP-C measured after operation （3h after admission） was significantly lower than that before operation, and the concentration of cTnI after operation was higher than that before operation. The difference was statistically significant （P < 0.05）; （3） There was a positive correlation between cMyBP-C and cTnI concentrations in groups a, B and C. the AUC value of ROC curve of cMyBP-C in diagnosing acute myocardial infarction with onset time less than 24 hours was 0.954, the sensitivity was 92.5%, and the specificity was 90.0%. Conclusion cMyBP-C, similar to cTnI, has the potential to be used as a biomarker for early diagnosis of myocardial infarction and as an early evaluation index for the condition and surgical effect after PCI. -
Key words:
- Cardiac myosin binding protein C /
- Troponin I /
- Acute myocardial infarction /
- Biomarkers
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图 1 cMyBP-C与cTnI的浓度相关性分析
Figure 1. Concentration correlation analysis of cMyBP-C and cTnI
表 1 一般临床资料比较（
$ \bar x \pm s $ ）Table 1. Comparison of general clinical data （
$ \bar x \pm s $ ）项目 A组（n = 40） B组（n = 20） C组（n = 60） D组（n = 30） 性别（男/女） 22/18 11/9 33/27 19/11 年龄（岁） 59.60 ± 10.46 65.15 ± 8.47 58.80 ± 9.87 61.13 ± 6.69 BMI（kg/m2） 24.50 ± 2.45 23.64 ± 1.99 24.36 ± 2.23 22.90 ± 2.35 SBP（mmHg） 132.20 ± 19.35 126.82 ± 10.12 129.12 ± 9.51 117.82 ± 12.32 DBP（mmHg） 78.21 ± 10.32 79.29 ± 7.82 78.23 ± 5.97 71.29 ± 6.89 FBG（mmol/L） 7.59 ± 3.18* 6.51 ± 0.85* 5.81 ± 0.73 5.21 ± 0.91 LDL-C（mmol/L） 3.27 ± 1.29* 3.49 ± 0.88* 2.37 ± 0.92 2.49 ± 0.78 与D组比较，*P < 0.05。 
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表 2 4组患者的cMyBP-C、cTnI浓度比较（
$ \bar x \pm s $ ）Table 2. Comparison of cMyBP-C and cTnI concentrations among the four groups （
$ \bar x \pm s $ ）项目 A组（n = 40） B组（n = 20） C组（n = 60） D组（n = 30） F P cMyBP-C（ng/mL） 228.99 ± 109.53 91.98 ± 19.07△ 100.62 ± 38.59△ 90.98 ± 21.60△ 31.22 < 0.001* cTnI（ng/mL） 1.25 ± 1.23 0.024 ± 0.020△ 0.024 ± 0.015△ 0.02 ± 0.01△ 26.06 < 0.001* *P < 0.05；与A组比较，△P < 0.05。
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表 3 PCI术前、术后cMyBP-C、cTnI的比较（
$ \bar x \pm s $ ）Table 3. Comparison of cMyBP-C and cTnI before and after PCI （
$ \bar x \pm s $ ）项目 PCI术前（n = 35） PCI术后（n = 35） t P cMyBP-C（ng/mL） 228.68 ± 101.44 99.02 ± 37.84△ 7.213 < 0.001* cTnI (ng/mL) 1.28 ± 1.20 31.13 ± 21.42△* −8.362 < 0.001* *P < 0.05；与PCI术前比较，△P < 0.05。
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表 4 发病时间 < 4 h的急性心肌梗死患者立即抽血cMyBP-C与cTnI浓度的比较（
$ \bar x \pm s $ ）Table 4. Comparison of cMyBP-C and cTnI concentrations in patients with acute myocardial infarction with onset time < 4 h （
$ \bar x \pm s $ ）项目 发病时间 < 4 h（n = 9） D组（n = 30） cMyBP-C（ng/mL） 130.23 ± 28.26* 90.98 ± 21.60 cTnI（ng/mL） 0.03 ± 0.01 0.02 ± 0.01 与D组比较，*P < 0.05。
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