心脏型脂肪酸结合蛋白持续增高对慢性心力衰竭患者不良结局的预测研究

Predictive research on the adverse outcome of persistently high level of heart-type fatty acid-binding protein in chronic heart failure patients

目的研究慢性心力衰竭(CHF)患者不同疾病阶段心脏型脂肪酸结合蛋白(H-FABP)的变化规律,探讨持续增高的H-FABP早期对其不良结局的预测价值。方法连续分析184例CHF患者(入院时、出院时)和100名正常对照者(正常对照组)血清H-FABP、B型纳尿肽(BNP)水平。依据测定结果进行分组,第1组患者(82例)的H-FABP处于较低水平,第2组患者(102例)的H-FABP持续处于高水平,对两组患者进行随访,观察其不良结局的发生情况。结果正常对照组H-FABP水平为≤0.6 ng/mL,第1组患者H-FABP在其入院及出院时均处于较低水平[3.042±0.914、(2.891±0.890)ng/mL];第2组患者H-FABP入院及出院时均处于较高水平[12.276±3.991、(9.374±3.116)ng/mL]。随访中,共有54例患者发生心血管事件(29.35%,54/184),其中24例因心血管事件而死亡、30例因心血管事件而再次入院。第1组中有10例(12.20%)患者发生心血管事件,第2组中有44例(43.14%)患者发生心血管事件,两组比较差异有统计学意义(P<0.01)。Kaplan-Meier曲线显示,相对于第1组而言,第2组无病生存率明显较低(P<0.001)。在心血管事件发生前平均27 d H-FABP即出现明显升高,而BNP出现明显升高的时间比心血管事件发生平均早10 d,H-FABP比BNP平均早17 d出现异常。单因素Cox比例风险模型显示年龄、纽约心脏病学会(NYHA)分级、BNP、H-FABP均与心血管事件相关,将其纳入多因素Cox比例风险模型分析,结果显示H-FABP持续高表达是未来发生心血管事件的独立影响因素(OR=5.462,P<0.000 1)。结论对CHF患者而言,H-FABP是一种较新的监测指标,能为早期预测患者预后、优化治疗方案提供有效的临床信息。

Objective To study the variation regularity of heart-type fatty acid-binding protein( H-FABP) at different stages in patients with chronic heart failure( CHF),and to investigate the predictive significance of persistently high level of H-FABP for early adverse outcome. Methods Serum H-FABP and B-type natriuretic peptide( BNP)levels were determined among 184 CHF patients at both admission and discharge and 100 healthy controls( healthy control group). According to the determination results,they were classified into 2 groups,low H-FABP level group( 82 cases,Group 1) and high H-FABP level group( 102 cases,Group 2). Follow-up study was made for the 2 groups,respectively,and their adverse outcomes were observed. Results The H-FABP level of healthy control group was≤0.6 ng/mL. The H-FABP levels of Group 1 were low at both admission and discharge[3. 042 ±0. 914,( 2. 891 ±0. 890) ng /mL]. The H-FABP levels of Group 2 were high at both admission and discharge[12. 276 ± 3. 991,( 9.374 ±3.116) ng/mL]. During the follow-up period,54 cases had cardiovascular events( 29. 35%,54/184,24 died cases and 30 readmitted cases). There were 10 cases( 12. 20%) in Group 1 and 44 cases( 43. 14%) in Group 2with cardiovascular events with statistical significance between the 2 groups( P < 0. 01). Kaplan-Meier curve showed Group 2 had evidently worse event-free rate than Group 1( P < 0. 001). H-FABP increased significantly before cardiovascular events with an average of 27 d,while BNP increased earlier than cardiovascular event occurrence with an average of 10 d. That of H-FABP was 17 d earlier than that of BNP. Univariate Cox proportional hazard analysis demonstrated that age,New York Heart Academy( NYHA) classification,BNP and H-FABP were all related to cardiovascular events. Multivariate Cox proportional hazard analysis showed that the persistently high level of H-FABP was an independent factor for cardiovascular events( OR = 5. 462,P < 0. 000 1). Conclusions Monitoring the level of H-FABP is a new tool that provides clinical information to predict prognosis and guide the therapy efficacy for CHF patients.