直接PCI后即刻心脏型脂肪酸结合蛋白与梗死心肌面积相关性研究

Single Heart-fatty Acid Binding Protein Soon After primary PCI Correlates with Infarct size

目的:以99锝-甲氧基异丁基异腈(99 mTc-MIBI)灌注成像获得梗死心肌面积为标准,验证急性心肌梗死(AMI)患者梗死相关血管(IRA)开通即刻血心脏型脂肪酸结合蛋白(H-FABP)浓度是否与梗死心肌面积相关。方法:连续入选38例首次AMI患者,测定其于发病12h内行急诊经皮冠状动脉内介入治疗(PCI)开通IRA后即刻血H-FABP浓度,于AMI发病第7d行单光子发射型断层计算机显像(SPECT)测定梗死心肌面积,进行相关关系研究。结果:SPECT测定梗死心肌面积STEMI组为(20.44±5.91)%LV,NSTEMI组为(10.91±4.66)%LV,前者显著高于后者。IRA开通即刻血H-FABP浓度分别为(34.74±12.29)μg/L、(18.14±7.286)μg/L。线性回归显示H-FABP与梗死面积显著相关。结论:单一测定IRA开通即刻血H-FABP浓度可以早期准确估测首次AMI患者梗死心肌面积。H-FABP有可能成为AMI早期诊断及判断其预后的新指标。

Objective: Exammine the ability of a single value of heart-fatty acid binding protein soon after primary PCI to estimate absolute infarct size.Methods: Infarct size were measured 7 days after STEMI/NSTEMI using 99 mTc-MIBI SPECT and blood for measurement of H-FABP were taken soon after primary PCI finished which were conduced in 12 hours after onset of STEMI/NSTEMI.Results: We enrolled 38 cases,27 STEMI,11 NSTEMI.99 mTc-MIBI SPECT imaging revealed an absolute infarct size of 20.4%LV for STEMI and 10.91%LV for NSTEMI.Absolute infarct sizes and H-FABP values were larger in STEMI than in NSTEMI.Linear regression analysis was excellent for STEMI(r=0.904) and moderate but still significant for NSTEMI(r=0.732).Conclusion: A single-point value of H-FABP soon after primary PCI can estimate accurately absolute infarct size in myocardial infarction.This ability may make H-FABP a useful clinical practice and as a clinical end point for quantification of infarct size.