心型脂肪酸结合蛋白对慢性阻塞性肺疾病患者早期心肌损伤评估的临床价值

The diagnostic value of heart-type fatty acid-binding protein for the early detecting myocardial injury in acute exacerbations of chronic obstructive pulmonary disease

目的探讨心型脂肪酸结合蛋白（H-FABP）与急性期慢性阻塞性肺疾病（COPD）患者心肌损伤的相关性,评价其筛查COPD患者早期心肌损伤的临床价值。方法收集2014年2~6月确诊的急性期COPD住院患者38例为疾病研究组,急性期支气管炎患者20例为疾病对照组,健康体检者20例为健康对照组。检测所有入选者血清H-FABP,并同步测定住院患者血清TNI、CK-MB、CK、BNP水平,比较同时期的心电图、超声心动图、肺功能及血气分析结果,与H-FABP进行关联性分析。结果在38例COPD急性期患者中,有31例（81.6%）H-FABP阳性,7例（18.4%）H-FABP阴性,而健康及疾病对照组经检测均为阴性。AECOPD患者H-FABP阳性组与其阴性组比较：心电图异常率85.7%vs.33.3%;超声心动图提示右心肥大的概率66.7%vs.0%,差异均有统计学意义（P〈0.05）。肺功能检查显示：急性加重期（AECOPD）患者H-FABP阳性组FEV1/FVC、FEV1%预计值均要显著低于阴性组（t=-3.42,P〈0.05;t=-2.90,P〈0.05）。对AECOPD患者进行病情分级,结果显示Ⅲ、Ⅳ级患者H-FABP阳性率（100%）明显高于Ⅰ、Ⅱ级组（40%）,P=0.01,差异有统计学意义。与传统的心肌标记物相比,TNI、CK-MB、CK对急性期COPD患者心肌损伤的诊断阳性率极低（〈5%）甚至为零,然而H-FABP阳性组相比阴性组,BNP水平（275.7±283.6）pg/ml vs.（35.1±28.8）pg/ml;TNI基线水平（0.015±0.024）ng/ml vs.（0.001±0.000）ng/ml,P〈0.05,差异有统计学意义。结论 H-FABP在评价急性期COPD心肌早期损伤中具有潜在的价值,其早期筛查方面要优于传统心肌指标如TNI、CK-MB、CK,可以作为COPD患者早期筛查心肌损伤、评估病情严重程度的灵敏指标。

Objective To explore the correlation between heart-type fatty acid-binding protein （H-FABP） and myocardial injury in patients with acute COPD （AECOPD）, and to evaluate its clinical value in COPD patients with myocardial injury. Methods Thirty-eight patients with continued acute exacerbations of COPD as disease group, 20 patients with acute bronchitis as-disease control group, 20 cases of healthy subjects were collected from February to June of 2014. The levels of serum H-FABP, TNI, CK-MB, CK, BNP in AECOPD patients and control subjects were detected. The correlation was performed between the results such as the same period electrocardiogram, echocardiography, pulmonary function, blood gas analysis and H-FABP. Results Thirty-one cases（81.6%） were H-FABP positive and 7 cases（18.4%） were H-FABP negative in 38 patients with AECOPD. All subjects both in health and disease control groups were I-I-FABP negative. Compared with H-FABP positive group and its negative group in AECOPD patients, we found the results as follows： ECG abnormal rate 85.7% vs. 33.3%; the abnormality of fight ventricular hypertrophy prompted on eehocardiography 66.7% vs. 0%. Above all P〈0.05, the difference between them was significant statistically. The pulmonary function tests showed H-FABP positive group FEV1/FVC and FEVI% values were significantly lower than the negative group （t=3.42, P〈0.05, t=-2.90, P〈0.05）. According to the disease classification for AECOPD patients, the results showed thatⅢ, IV grade H-FABP positive rate （100%） was significantly higher than I, Ⅱgrade group （40%）, the difference was statistically significant （P=0.01）. Compared to the traditional indicators of myocardial injury, TNI, CK-MB, CK-positive rate was very low （〈5%） or even zero for diagnosing myocardial injury in CODP patients. However, compared with H-FABP positive group and negative group, the level of BNP （275.7±283.6）pg/ml vs. （35.1±28.8）pg/ml; the baseline level of TNI （0.015±0.024）ng/ml vs. （0.001±0.000）ng/ml were all statistically significant （P〈0.05）. Conclusion H-FABP has a potential value in the evaluation of early myocardial injury in AECOPD patients and it is superior to the traditional indicators such as TNI, CK-MB, CK. H-FABP can use an effective indicator to screen early myocardial damage and to assess the severity of disease in AECOPD patients.