| Abstract | Akutni infarkt miokarda (AIM) pojavljuje se kada je protok krvi u području srčanog mišića nenadano blokiran. Prema Svjetskoj zdravstvenoj organizaciji (SZO), dijagnoza infarkta miokarda postavlja se na temelju prisutnost najmanje dvaju od vodećih triju kriterija, a to su: bol u prsištu, promjene na EKG-u te povećanje srčanih biljega najmanje 2 puta od normalnih vrijednosti (2). Cilj je istraživanja bio procijeniti dijagnostičku korist cTnI-ja, mioglobina, H-FABP-a i kopeptina u dijagnosticiranju akutnog infarkta miokarda. Ispitanici i metode U istraživanje je bilo uključeno 65 ispitanika koji su na temelju konačne dijagnoze koju je utvrdio liječnik s obzirom na sve dijagnostičke i kliničke pokazatelja bili podijeljeni u dvije skupine: 29 pacijenata s NSTEMI AIM-om te 36 kontrolnih ispitanika. Za istraživanje su se rabili preostali uzorci venske krvi prikupljeni venepunkcijom u epruvetu bez antikoagulansa pacijenata sa simptomima koji upućuju na mogući akutni infarkt miokarda, a koji su primljeni na Objedinjenom hitnom prijemu KBC-a Osijek. Uzorci venske krvi centrifugirali su se 10 minuta na 3500 rpm, a serum je poslužio za mjerenje koncentracija cTnI-ja, mioglobina, H-FABP-a i kopeptina. Koncentracije cTnI-ja izmjerene su kemiluminiscentnom imunoanalizom baziranom na LOCI tehnologiji, a mioglobin heterogenom imunoanalizom na Dimension EXL s LM analizatoru (Siemens Healthcare Diagnostics Inc., Newark, SAD). H-FABP je izmjeren na Beckman Coulter AU 480 analizatoru (Beckman Couter Inc., Brea, SAD) imunoturbidimetrijskom metodom (Randox Laboratories Ltd.). Kopeptin je izmjeren heterogenom enzimimunokemijskom metodom (ELISA) na analizatoru Labsystems iEMS Reader MF (LabsystemsOy, Helsinki, Finska). Rezultati Vrijednosti H-FABP-a bile mnogo više u pacijenata s NSTEMI AIM-om nego u kontrolnoj skupini (NSTEMI AIM: 10,7±7,0μg/L, kontrolni ispitanici: 6,9±3,8μg/L, P = 0,001). Vrijednosti mioglobina također su bile više u bolesnika s NSTEMI AIM-om uusporedbi s kontrolnom skupinom (NSTEMI AIM: 87±51μg/L, kontrolni ispitanici: 62±42μg/L, P = 0,034). Vrijednosti koncentracija kopeptina nisu se razlikovale među SAŽETAK 18 Rani laboratorijski biljezi infarkta miokarda skupinama (NSTEMI AIM: 102,2±28,0 ng/L, kontrolni ispitanici: 105,8±59,3 ng/L, P = 0,764). Prema rezultatima ROC analize, H-FABP je imao AUC vrijednost 0,698 (osjetljivost: 83%, specifičnost: 56%), vrijednost mioglobina 0,675 (osjetljivost: 83%, specifičnost: 50%), a kopeptina 0,570 (osjetljivost: 97%, specifičnost: 25%). Zaključak Istraživanje je pokazalo da je H-FABP bolji biljeg u stratifikaciji pacijenata s bolom u prsištu od mioglobina i kopeptina te bi njegova primjena bila korisna pri isključivanju AIM-a. |
| Abstract (english) | Introduction Acute Myocardial Infarction (AMI) occurs when blood flow to the heart muscle area is suddenly blocked. According to the World Health Organization (WHO) myocardial infarction diagnosis is based on the presence of at least 2 of the leading 3 criteria, namely: chest pain, ECG changes, and heart rate increase at least 2 times the normal values (2). The aim of the study was to evaluate the diagnostic benefit of cTnI, myoglobin, H-FABP and copeptin in the diagnosis of acute myocardial infarction. Materials and Methods Sixty five subjects were included in the study, all based on the final diagnosis given by the medic, and according to the diagnostic and clinical indicators the subjects were divided into two groups: 29 patients with NSTEMI AIM and 36 controled subjects. For the study, the remaining samples of venous blood were used, collected by venipuncture in the non-anticoagulant tube of patients with symptoms indicating possible acute myocardial infarction, which were received at integrated emergency reception of Clinical Hospital Centre Osijek. Venous blood samples were centrifuged for 10 minutes at 3500 rpm and serum was used to measure cTnI, myoglobin, H-FABP and copeptin concentrations. CTnI concentrations were measured by chemiluminescence immunoassay based on LOCI technology and myoglobin was measured by heterogeneous immunoassay on Dimension EXL with LM analyzer (Siemens Healthcare Diagnostics Inc., Newark, USA). H-FABP was measured by the Beckman Coulter AU 480 analyzer (Beckman Couter Inc., Brea, USA) by immunoturbidimetric method (Randox Laboratories Ltd.). Copeptin was measured by a heterogeneous enzyme immunochemical assay (ELISA) on the Labsystems iEMS Reader MF (LabsystemsOy, Helsinki, Finland) analyzer. Results The H-FABP values were significantly higher in patients with NSTEMI AIM than in the controled group (NSTEMI AIM: 10.7 ± 7.0 μg / L, controled subjects: 6.9 ± 3.8 μg / L, P = 0.001) . Myoglobin values were also higher in patients with NSTEMI AIM compared to controled group (NSTEMI AIM: 87 ± 51 μg / L, controled subjects: 62 ± 42 μg / L, P = 0.034). The concentration values of the copeptin did not differ between the groups (NSTEMI AIM: 102.2 ± 28.0 ng / L, controled subjects: 105.8 ± 59.3 ng / L, P = 0.764). According to the results of the ROC analysis, H-FABP had an AUC value of 0.698 (sensitivity: 83%, specificity: 56%), myoglobin 0.675 (sensitivity: 83%, specificity: 50%), and copeptin 0.570 (sensitivity: 97%, specificity: 25 %). Conclusion The study has shown that H-FABP is a better marker for stratification of chest pain than myoglobin and capeptin, and its use was effective when excluding AIM. |
