心脏型脂肪酸结合蛋白对人院时血流动力学稳定的急性肺栓塞患者短期预后的评估

Heart-type fatty acid binding protein for the assessment of the short-term prognosis in acute pulmonary embolism patients with hemodynamic stability on admission

目的探讨心脏型脂肪酸结合蛋白（H—FABP）对入院时血流动力学稳定的急性肺栓塞患者短期预后评估的临床意义。方法筛选2009年12月至2010年12月在北京安贞医院就诊并被确诊的入院时血流动力学稳定的急性肺栓塞患者156例，其中符合纳入标准90例，男37例，女53例，平均年龄（61．1±14．6）岁，留取溶栓或抗凝前的外周静脉血标本，应用双抗体夹心酶联免疫吸附法测定H—FABP浓度，非均相免疫法测定肌钙蛋白I（cTnI）、N-末端脑钠肽前体（NT—proBNP）浓度，所有患者随访30d，根据随访结果分为复杂临床过程组（7例）和简单临床过程组（83例），结果采用Mann—WhitneyU检验、x2检验、x。检验的连续性校正及logistic回归进行分析。结果复杂临床过程组H—FABP水平高于简单临床过程组（U=54．000，P〈0．叭）；ROC曲线获得H—FABP的最佳预后截值为7μg／L，H—FABP、cTnI和NT—proBNP三者之间AUC比较差异无统计学意义；单变量logistic回归分析发现H—FABP-6μg／L、心率≥106／min和晕厥（均P〈0．01）可预测血流动力学稳定的急性肺栓塞患者短期不良预后；多变量logistic回归分析发现仅H—FABP≥6μg／L和晕厥（均P〈0．05）仍是独立预测因素；cTnI或NT—proBNP联合H—FABP可提高对血流动力学稳定的急性肺栓塞患者治疗30d的预测价值。结论单独应用H—FABP或H—FABP联合其他临床资料，可对入院时血流动力学稳定的急性肺栓塞患者治疗30d的预后进行评估，H—FABP作为预后评估可能优于cTnI和NT—proBNP。

Objective To explore the clinical value of heart-type fatty acid binding protein （H-FABP） for the assessment of the short-term prognosis in acute pulmonary embolism （APE） patients with hemodynamie stability on admission. Method A total of 156 APE patients with hemodynamic stability on admission were hospitalized in Beijing Anzhen hospital from December 2009 to December 2010, and the final study population comprised 90 patients [37 men and 53 women; age （61.1 ± 14. 6） years , who were taken blood samples before thrombolysis or anticoagulation for plasma H-FABP level measurement by a solid-phase enzyme-linked immunoabsorbent assay based on the sandwich principle, cardiac troponin I （cTnI） and N- terminal pro-brain natriuretic peptide （NT-proBNP） by heterogeneous immunoassay. All had 30-day follow- up and divided them into the complicated clinical course group （ n = 7 ） and the simple clinical course group （ n = 83 ）. The clinical and follow-up data was analyzed by Mann-Whitney U test, Pearson Cbi-Square test, Continuity Correction test and logistic regression. Results The level of H-FABP was higher in the complicated clinical course group than it in the simple clinical course group （U =54. 000 ,P 〈0.01 ）. With ROC analysis, 7 tzg/L was identified as the best cutoff value of H-FABP in this study, and the differences of AUC among H-FABP, cTnI and NT-proBNP were no statistical significance. By univariable logistic regression, H-FABP I〉 6 μg/L, heart rate I〉 106 beats/min and syncope （ all P 〈0. 01 ） may predict the short-term prognosis in APE patients with hemodynamic stability. H-FABP 〉I 6 μg/L and syncope （ both P 〈 0. 05） may also be 30-day predictor by multivariable logistic regression. NT-proBNP or cTnI combined with H-FABP may increase 30-day prognosis value in APE patients with hemodynamic stability. ConclusionsH-FABP, alone or in combination with other clinical data may predict 30-day prognosis in APE patients with hemodynamie stability on admission. H-FABP is superior to cTnI and NT-proBNP in the predication of 30- day prognosis in APE patients with hemodynamic stability on admission.