心脏瓣膜置换围手术期H—FABP和cTnI的变化及意义

The change and significance of heart fatty acid-binding protein and cardiac troponin I in valve replacement patients

目的探讨心脏瓣膜置换术后心肌肌钙蛋白I（cTnI）和心型脂肪酸结合蛋白（H—FABP）的变化规律。方法选本院风湿性心脏病手术患者40例，随机分为晶体停搏液灌注组和冷血停搏液灌注组，选取8个时间点，分析和比较各时点血清cTnI和H—FABP浓度变化规律。结果晶体停搏液灌注组cTnI组间及交互效应差异均有统计学意义（F组间=2744．397，P〈0．01；F交互=125．345，P〈0．01），冷血停搏液灌注组cTnI组间及交互效应差异均有统计学意义（F组间=1056．357，P〈0．01；F交互=64．242，P〈0．01）；晶体停搏液灌注组H—FABP组间及交互效应差异均有统计学意义（F组间=1775．022，P〈0．01；F交互=34．297，P〈0．01），冷血停搏液灌注组H—FABP组间及交互效应差异均有统计学意义（F组间=3064．451，P〈0．01；F交互=60．472，P〈0．01）。结论H—FABP心肌的特异性强，有效诊断窗口期短，较符合心肌损伤的理想判定标志物。

Objective To explore change trend of Cardiac Troponin I （cTnI） and Heart Fatty Acid-binding Protein（H-FABP） in serum during the perioperation of valve replacement. Methods Forty patients with heumatoid valvular heart disease were selected for this study, and the patients were randomly divided into two groups. Blood samples were taken from center vein, and the serum levels of cTnI and H- FABP were determined. The change of the serum levels of these two markers at different time points was recorded and compared between two groups. Results There were significant differences in the concentration of cTnI in the cold crystalloid cardioplegia group （ F between group = 2744. 397, P 〈 0. 01 ; F interaction = 125. 345, P 〈 0. 01 ）. There were significant differences in the concentration of eTnI in the cold blood cardioplegia group （ F between group = 1056. 357, P 〈0. 01; F interaction =64. 242, P 〈 0. 01 ）. There were significant differences in the concentration of H - FABP in the cold crystalloid cardioplegia group （ F between group = 1775. 022, P 〈 0. 01 ; F interaction = 34. 297, P 〈 0. 01 ）. There were significant differences in the concentration of H - FABP in the cold blood cardioplegia group （ F between group = 3064. 451, P 〈 0. 01; F interaction = 60. 472, P 〈 0. 01 ）. Conclusions H-FABP is suitable for early diagnosis of myocardial injury because of its myocardial specificity. There are positive correlation between the peak of H-FABP and myocardial injury. There are effective and short period of window for prediction of myocardial injury caused by H-FABP. H-FABP may be served as a good myocardial injury diagnostic markers.