直接经皮冠状动脉介入治疗术前、术后血清心型脂肪酸结合蛋白水平与急性ST段抬高心肌梗死患者预后的相关性

Relationship between serum heart-type fatty acid binding protein levels before and after primary percutaneous coronary intervention and prognosis of patients with ST-segment elevation acute myocardial infarction

目的观察直接经皮冠状动脉介入治疗（pPCI）术前、术后血清心型脂肪酸结合蛋白（H-FABP）水平与急性ST段抬高心肌梗死（STEMI）患者术后6个月预后的相关性。方法连续选取粤北人民医院2014年11月至2015年5月STEMI患者共77例,均于发病12 h内行pPCI术,于pPCI术前5 min内及发病后24 h检测血清H-FABP浓度。记录患者一般信息、相关检查化验结果、手术相关情况、心血管疾病危险因素等,随访术后6个月内主要不良心血管事件（MACE）发生情况。结果（1）Pearson相关分析显示：术前血清H-FABP浓度与STEMI患者冠状动脉病变Gensini积分呈正相关（r=0.753,P〈0.01）;术后血清H-FABP浓度与Gensini积分亦呈正相关（r=0.388,P〈0.05）,但相关性较差;术前血清H-FABP浓度与STEMI患者心肌梗死范围（MIA）呈正相关（r=0.792,P〈0.01）;术后血清H-FABP浓度与STEMI患者MIA亦呈正相关（r=0.296,P〈0.01）,但相关性欠佳。（2）术前以血清H-FABP浓度=106.35 ng/ml为最佳临界值,预测STEMI患者行pPCI术后6个月内发生MACE的敏感度为92.0%,特异度为80.1%,ROC曲线下面积为0.901（95%CI 0.830-0.973,P〈0.01）。术后以血清H-FABP浓度=31.85 ng/ml为最佳临界值,预测STEMI患者行pPCI术后6个月内发生MACE的敏感度为88.4%,特异度为52.6%,ROC曲线下面积为0.734（95%CI 0.618-0.851,P=0.002）。（3）随访6个月,共20例患者发生MACE。单因素Cox回归模型发现,术前血清H-FABP浓度（P〈0.01）、术后血清H-FABP浓度（P=0.04）均为STEMI患者行pPCI术后6个月内发生MACE的危险因素。多因素Cox回归模型发现,术前血清H-FABP浓度（P=0.008）、糖尿病史（P=0.038）、心肌肌钙蛋白I峰值（P=0.006）、氨基末端B型脑钠肽前体（P=0.021）为STEMI患者行pPCI术后6个月内发生MACE的主要危险因素。结论对于行pPCI的STEMI患者,术前血清H-FABP浓度可能是其术后6个月内发生MACE的独立危险因素。

Objective To observe the relationship between serum H-FABP levels before and after pPCI and the severity of coronary artery lesions and preoperative myocardial infarction area, and to further investigate the relationship between H-FABP levels and prognosis of patients with ST-segment elevation acute myocardial infarction. Methods Blood samples of 77 patients admitted for ST-segment elevation acute myocardial infarction between November 2014 to May 2015 were taken before pPCI and 24 hours after symptoms onset for measurment of serum H-FABP levels. All patients received pPCI within 12 hours ofsymptoms onset. Severity of coronary artery lesions were evaluated by using Gensini scoring system. According to the Gensini score from low to high, all patients were divided into different groups. Myocardial infarction areas （MIA） were estimated by using Aldrich forumla. Subgroup analysis was also performed among patients with different MIA. Demographic characteristics, laboratory results, procedural information and cardiovascular risk factors were recorded. Major adverse cardiovascular events （MACE） were followed up and recorded for 6 months after pPCI. Results Serum levels of H-FABP before and after pPCI were significantly elevated than the upper normal limit （5 ng/ml） with statical difference [ （101.36±72. 50）ng/ ml vs. （42. 97 ± 32. 03 ） ng/ml, P 〈 0. 01 ]. Serum level of H-FABP before and after pPCI were elevated direct proportionally as Gensini scores increased （ P 〈 0. 05 ）. Correlation analysis indicated that serum levels of H-FABP before pPCI was positively correlated with Gensini score before （r =0. 753 ,P 〈0. O1 ） and after pPCI （ r = 0. 388, P 〈 0. 05 ）. Serum levels of H-FABP before pPCI were elevated in different groups as MIA increased （ P 〈 0, 05 ） , but no significant differences in serum level of H-FABP after pPCI were observed among different groups of MIA （ P 〉 0. 05）. Correlation analysis indicated that serum levels of H-FABP was positively correlated with MIA before （r = 0. 792,P 〈0. 01 ） and after pPCI （ r = 0. 296, P 〈 0. 05 ）. Cutoff value of H-FABP before pPC1 of 106. 35 ng/ml （with sensitivity of 92. 0% and specificity of 80. 1% ） was found to be best for predicting MACE in 6 months after pPCI. During the follow-up period of 6 months, 20 cases of MACE were recorded. Univariate Cox regression analysis showed that serum concentration of H- FABP before pPCI （P 〈0. 01 ） and serum level of H-FABP after pPCI （P =0. 04） were the independent risk factors of MACE within 6 months. Multivariate Cox regression analysis found that the serum level of H-FABP before pPC1 （ P = 0. 008 ）, diabetes （ P 〈 0. 038 ）, peak of cTnI （ P = 0. 006 ） and NT-proBNP （ P = 0. 021 ） were major risk factors of MACE. Conclusions Serum concentration of H-FABP before pPCI is found to be an independent risk factor of MACE within 6 months in STEMI patients treated with pPCI.