重型颅脑损伤患者心肌损害的早期诊断

The early diagnosis of myocardial damage in patients with severe head injuries

目的探讨重型颅脑损伤患者心肌损害的早期诊断及心脏型脂肪酸结合蛋白（h-FABP）对患者预后的影响。方法血清h-FABP采用双抗体夹心酶联免疫一步法定量检测，cTnI采用固相酶联免疫吸附试验（ELISA），CK-MB采用免疫抑制法。结果重型颅脑损伤患者组血清h-FABP、cTnI及CK-MB水平分别显著高于健康对照组（P〈0．01），重型颅脑损伤患者血清h-FABP阳性率显著高于血清cTnI、CK-MB或心电图的阳性率（P〈0．01），47例重型颅脑损伤患者治疗后死亡8例，病死率为17．02％（8／47），血清h-FABP、cTnI及CK-MB异常组的病死率显著高于正常组（P〈0．01）；重型颅脑损伤患者血清h-FABP预测发生死亡具有高的敏感性和阴性预测值，但特异性和准确度较低。结论血清h-FABP定量测定作为一种对微小心肌损伤高敏感的指标，可作为判断重型颅脑损伤急性期病情轻重、评价发生意外的一项客观指标。

Objective Discuss the influence of early diagnosis of myocardial damage and heart-type fatty acid binding protein （h-FABP） on patients with severe head injury after rehabilitation. Methods The serum h-FABP was detected using enzyme-linked immunosorbent one-step quantitative detection, cTnI using solid-phase enzyme-linked immunosorbent assay （ ELISA）, CK-MB using the method of immunosuppressive. Results The serum levels of h-FABP, cTnI and CK-MB in severe head injury patients levels were significantly higher than that of healthy control groap（P 〈0. 01 ）, the positive serum h-FABP in severe head injury patients was significantly higher than cTnI, CK-MB or ECG（P 〈 0. 01 ） ; 8 cases died in 47 cases of severe head injury patients, the mortality rate was 17. 02% （8/47）, the mortality rate of abnormal serum h-FABP, cTnI and CK-MB group was significantly higher than the normal group（P 〈 0.01 ） ; The serum h-FABP in predicting the death of severe head injury patients was high in sensitivity and negative predictive value, but lower in specificity and accuracy. Conclusions The serum h-FABP quantitative assay as a high-sensitive indicators to minor myocardial damage can be used as an objective indicators for judging severity of acute severe head injury, evaluating incidence of accidents.