心型脂肪酸结合蛋白、肌钙蛋白I与急性冠脉综合征冠状动脉病变程度的相关分析

Relationship of heart-type fatty acid-binding protein levels and troponins I with coronary artery stenosis in patients with acute coronary syndrome

目的探讨心型脂肪酸结合蛋白(H-FABP)、肌钙蛋白I(cTnI)与近期发作急性冠脉综合征(ACS)的患者冠状动脉病变严重程度的相关性及原因分析。方法ACS患者于发作12h内入院,1周内行冠脉造影者98例入选,其中急性心肌梗死(AMI)21例、不稳定型心绞痛(UAP)77例。采用双抗体夹心ELISA法定量测量待测血清H-FABP、cTnI;根据美国心脏病协会所规定的冠状动脉血管图像记分分段评价标准,对病变狭窄程度进行分度、累及血管支数计算,采用Gensini积分系统,对冠脉血管病变狭窄程度、病变部位、范围进行定量评定;用卡方检验分析血H-FABP、cTnI与狭窄程度、病变支数的相关性;采用二元回归分析方法分析血清H-FABP、cTnI与患者冠状动脉病变严重程度的相关性。结果H-FABP≥8.0mg/L组与H-FABP<8.0mg/L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异(P<0.01);cTnI≥1.0mg/L组与cTnI<1.0mg/L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异(P<0.01);血清H-FABP、cTnI与患者冠状动脉病变严重程度的二元线性回归方程:Y=15.664+2.833x1+1.034x2(Y为Gensini积分,x1血中H-FABP浓度,x2为cTnI浓度);标准回归系数r为0.518和0.253(P<0.01)。结论H-FABP、cTnI与近期发作ACS的患者冠状动脉病变严重程度呈正相关,H-FABP与冠脉病变程度相关程度更高。血清H-FABP、cTnI升高是冠状动脉病变急性加重的直接结果,临床可根据血清H-FABP升高推断冠脉病变的危险度并采取积极的治疗措施。

Objective To evaluate the relationship between heart-type fatty acid-binding protein （H-FABP）, troponins Ⅰ（cTnⅠ） levels and coronary artery lesions in patients with acute coronary syndrome （ACS）, and to analyze the reasons. Methods Ninety-eight patients came to hospital within 12 hours after onset of chest pain and diagnosed as ACS. Among these 98 cases, there were 21 patients with acute myocardial infarction（AMI） ,77 cases with unstable angina pectoris（UAP）. The serum level of H-FABP and cTnⅠ was measured by sandwich ELISA. According to Gensini＇s scoring system, the severity, locations of vascular stenosis were analyzed. The relationship of serum H-FABP, cTnⅠ with vascular stenosis was analyzed. Results There was significant difference in Gensini＇ s score, amounts of lesion vessels and stenosis severity between H-FABP ≥ 8.0 mg/L group and H-FABP 〈 8.0 mg/L group （P 〈 0.01 ）, between cTnⅠ ≥ 1.0 mg/L group and cTnⅠ 〈 1.0 mg/L group . The linear regression equations was ＂Y = 15. 664 ＋ 2. 833x1 ＋ 1. 034 x2＂, ＂ Y＂ representing Gensini＇s score, ＂x1 ＂ representing H-FABP levels and x2 standing for cTnⅠ. Standardized coefficients were 0. 518 and 0. 253 respectively （ P 〈 0. 01 ）. Conclusions The elevated serum levels of H-FABP and cTnⅠ might be due to coronary artery lesions in patients with ACS. Coronary artery lesions can be estimated by the elevated serum H-FABP and cTnⅠ levels.