血清H-FABP检测对AMI患者诊断及预后和死亡风险评估的价值研究

Research on the significance of serum H-FABP determination for diagnosis,prognosis and death risk evaluation in patients with acute myocardial infarction

目的探讨心型脂肪酸结合蛋白（H-FABP）浓度变化对急性心肌梗死（AMI）患者诊断、预后及死亡风险评估的意义。方法采用双向侧流免疫法检测72例AMI患者、44例不稳定心绞痛（UAP）患者、30名健康对照者以及64例AMI患者治疗后第3天、第7天血清H-FABP和心肌肌钙蛋白Ⅰ（cTnI）水平。所有患者平均随访180 d,观察随访期间发生的主要不良心脏事件（MACE）。结果 AMI组血清H-FABP水平明显高于UAP组及对照组（P〈0.01）。血清H-FABP水平与cTnI呈正相关（r=0.53,P〈0.01）。AMI组和UAP组H-FABP阳性率明显高于cTnI（P〈0.05）。治疗前,死亡组与非死亡组血清H-FABP水平差异无统计学意义（P〉0.05）;治疗后第3天,无MACE组血清H-FABP水平明显降低（P〈0.01）且低于正常参考范围,而MACE组和死亡组仍高于正常参考范围;治疗后第7天,MACE组比治疗前显著降低（P〈0.01）,并低于正常参考范围;死亡组血清H-FABP水平与治疗前比差异无统计学意义（P〉0.05）,且仍高于正常参考范围。AMI患者血清H-FABP水平与心功能分级[美国纽约心脏病协会（NYHA）Ⅰ~Ⅳ]呈正相关（r=0.51,P〈0.01）。结论血清H-FABP可作为AMI的一种标志物,对AMI早期诊断有重要临床价值。观察治疗过程中血清H-FABP水平动态变化对AMI患者预后评估有重要意义。

Objective To study the significance of serum heart-type fatty acid-binding protein（H-FABP）levels for the diagnosis,prognosis and death risk evaluation in patients with acute myocardial infarction（AMI）.Methods The serum H-FABP and cardiac troponin I（cTnI） levels of 72 patients with AMI,44 patients with unstable angina pectoris（UAP）,30 healthy controls and 64 patients with AMI treated on the 3rd d and 7th d were measured by bi-directional lateral flow immunoassay.The main adverse cardiovascular events（MACE）were observed for 180 d.Results The serum H-FABP levels in the AMI group were significantly higher than those in the UAP group and the control group,and the serum H-FABP level was positively correlated with serum cTnI levels（r=0.53,P0.01）.The positive rates of H-FABP in the AMI group and the UAP group were significantly higher than those of cTnI（P0.05）.Before the treatment,the serum H-FABP levels of death group and non-death group were not significantly different（P0.05）.On the 3rd d after the treatment,the serum H-FABP levels in non-MACE group were significantly lower than the normal reference value（P0.01）,and the serum H-FABP levels of MACE group and the death group were higher than the normal reference value.On the 7th d after the treatment,the serum H-FABP levels in MACE group were significantly lower than those before the treatment（P0.01）,and were lower than the normal reference value.The serum H-FABP levels of the death group before and after the treatment had no significant difference（P0.05）,and were higher than the normal reference value.The serum H-FABP levels were positively correlated with the grade of New York Heart Associaion（NYHA） Ⅰ-Ⅳ（r=0.51,P0.01）.Conclusions The serum H-FABP is a marker for AMI.There is an important clinical value of the serum H-FABP detection for the early diagnosis in patients with AMI.Observing the changes of serum H-FABP levels in the course of treatment has important significance in the prognosis evaluation in patients with AMI.