心脏型脂肪酸结合蛋白在急性冠脉综合征中检测的意义

Significance of heart-type fatty acid binding protein in patients with acute coronary syndrome

目的：探讨心脏型脂肪酸结合蛋白（H-FABP）在急性冠脉综合征中检测的意义。方法将102例急性冠脉综合征分为不稳定型心绞痛（UA）35例，非 ST 段抬高急性心肌梗死（NSTEMI）49例和 ST 段抬高急性心肌梗死（STEMI）18例。另外选择40例健康人为正常组。测定血清肌钙蛋白（cTnI）和 H-FABP。结果 UA、NSTEMI、STEMI 组血清 cTnI 和 H-FABP 均高于正常组（P ﹤0.01），NSTEMI 组血清 cTnI 和 H-FABP 均高于 UA 组（ P ﹤0.01），STEMI 组血清 cTnI 和 H-FABP 均高于 NSTEMI 组（P ﹤0.01）。在胸痛发作后2、4、6 h 血清中 H-FABP 阳性率明显高于 cTnI 阳性率，两者比较差异有统计学意义（P ﹤0.05），胸痛发作后12 h，血清中 H-FABP 阳性率明显低于 cTnI 阳性率，两者比较差异有统计学意义（P ﹤0.05）。血清 cTnI 和 H-FABP 在高危组均高于中危组、低危组（P 均﹤0.05），在中危组高于低危组（P 均﹤0.05）。血清 cTnI 和 GRACE 评分呈正相关（r =0.27，P ﹤0.05），血清H-FABP 和 GRACE 评分呈正相关（r =0.58，P ﹤0.05）。血清 H-FABP 和 GRACE 评分的相关系数大于血清 cTnI 和GRACE 评分的相关系数。结论 H-FABP 对急性冠脉综合征的诊断和危险分层更敏感。

Objective To study the significance of heart-type fatty acid binding protein（ H-FABP）in patients with acute coronary syndrome. Methods One hundred and two cases of acute coro-nary syndrome were divided into unstable angina（UA）（35 cases）,non-ST segment elevation acute my-ocardial infarction（NSTEMI）（49 cases）and ST segment elevation acute myocardial infarction（STE-MI）（18 cases）. Forty cases of normal healthy people were enrolled into the normal group. Serum cTnI and H-FABP levels were detected. Results Serum cTnI and H-FABP levels in UA,NSTEMI,STEMI were higher than those in the normal group（P ﹤ 0. 01）. Serum cTnI and H-FABP levels in NSTEMI were higher than those in the UP group（P ﹤ 0. 01）. Serum cTnI and H-FABP levels in STEMI were higher than those in the NSTEMI group（P ﹤ 0. 01）. After 2,4,6 hours of the onset of chest pain,serum H-FABP levels was significantly higher than cTnI positive rate,there were significant differences（P ﹤0. 05）. After 12 hour of the onset of chest pain,the serum H-FABP positive rate was significantly lower than cTnI positive rate,there was significant difference（P ﹤ 0. 05）. Serum cTnI and H-FABP levels in the high-risk group were higher than the low-risk group（P ﹤ 0. 05）. The intermediate-risk group were higher than the low risk group（P ﹤ 0. 05）. Serum cTnI and GRACE score had a significant positive cor-relation（r = 0. 27,P ﹤ 0. 05）. Serum H-FABP and GRACE score had a significant positive correlation （r = 0. 58,P ﹤ 0. 05）. The correlation coefficient of serum H-FABP and GRACE score was greater than the correlation coefficient of serum cTnI and GRACE score. Conclusions H-FABP is more sensitive in the diagnosis and risk stratification of acute coronary syndrome.