心肌脂肪酸结合蛋白变化与OPCAB后心肌梗死

Relationship between the change of heart-fatty acid-binding protein and myocardial injury/infarction in postoperative of off-pump coronary artery bypass grafting

目的探讨心肌型脂肪酸结合蛋白（H—FABP）与非体循环外冠状动脉旁路移植术（OPCAB）后心肌损伤及心肌梗死的关系。方法59例首次单纯行OPCAB的患者，分别于麻醉诱导后、CABG手术结束（最后1支旁路血管吻合完毕）、入ICU即刻、2、4、8h及术后1天抽取中心静脉血检测H—FABP含量；于术前、入ICU4、8h、术后1、2天分别常规化验cTnI、CK—MB。根据术后8h的cTnl值及心电图的改变将患者分为正常组（I组，cTnI〈0．1ng／m1）、心肌损伤组（II组，cTnl0．1～1．0ng／m1）、心肌梗死组（Ⅲ组，cTnI〉1ng／m1）。结果心肌梗死组的H-FABP显著高于心肌损伤组及正常组（P〈0．01），H—FABP与cTnI、CK—MB有良好的相关性。H—FABP在入ICU2h达峰值，显著早于cTnI、CK-MB（P〈0．01），且入ICU4h即开始下降，术后i天回到基线水平。而cTnI、CK—MB达峰值的时间分别是术后8h和1天，且术后2天仍维持在较高水平。结论H—FABP与OPCAB围手术期心肌梗死有良好的相关性，且与“金标准”cTnI比较具有一定的优越性，早期监测H—FABP对诊断围手术期心肌梗死具有较为突出的应用价值。

Objective To evaluate the relationship between the change of Heart-fatty acid-binding protein and myocardi- al injury/infarction in postoperative of off-pump coronary artery bypass grafting （OPCAB）. Methods 59 patients （ male 37 and female 22, from 46 to 83 years old） who were the first time to undergoing OPCAB were included in this study. Serial ve- nous blood samples were taken at after induction of anesthesia, the OPCAB finished （ after the last anastomosis）, entered ICU, 2, 4 and 8 hours after the patient entered ICU, and at 1 and 2 day postoperative to test H-FABP. The cTnI and CK-MB were tested at 4 and 8 hours, after entering ICU, and at 1 and 2 days postoperative. Patients were divided into 3 groups by the chan- ges of ECG and the level of cTnI at g hours after they entered ICU ： normal group （ group I , cTnI 〈 0.1 ng/ml）, myocardial in- jury group（ group II , cTnI 0.1 - 1.0 ng/ml） and. myocardial infarction group（ group m, cTnI 〉 1.0 ng/ml） . Results The level of H-FABP released was significantly higher in the myocardial infarction group than normal group and myocardial injury group （ P 〈 0.01 ）. There is good correlation between the H-FABP and cTnI or CK-MB. But the peak level of H-FABP is earli- er （ finished OPCAB） （ P 〈 0.05 ） , and it peaked early at 2h after entered ICU （ P 〈 0.01 ） , it began to decrease at 4 hours af- ter entered ICU and returned to baseline at 1 day postoperative, while the cTnI and CK-MB peaked at postoperative day 1 and 8h after entered ICU respectively, and maintained in higher level at postoperative 2 days. Conclusion There is good correla- tion between the H-FABP and perioperative myocardial infarction in OPCAB, and it has superiority compared with cTnI, which is as ＂ gold standard＂ for perioperative myocardial infarction, on a certain degree. It can benefit from early detection of H-FABP for myocardial infarction in perioperative of OPCAB.