hs-cTnI和H-FABP与急性冠脉综合征病变程度及危险分层的研究

Relationship between serum concentration of hs-cTnI, H-FABP and severity of coronary artery lesion and risk stratification in acute coronary syndrome

目的探讨高敏肌钙蛋白I(hs-cTnI)和心型脂肪酸结合蛋白(H-FABP)对急性冠脉综合征(ACS)冠脉病变严重程度及危险分层的意义。方法选取上海交通大学医学院附属瑞金医院ACS患者152例,根据ACS的诊断标准分为不稳定心绞痛(UAP)组24例(16%)、ST段抬高型心肌梗死(STEMI)组72例(47%)和非ST段抬高型心肌梗死(NSTEMI)组56例(37%)。根据美国心脏病协会(ACC)规定的冠脉血管图像积分分段评价标准,采用Gensini积分系统对患者冠脉血管的病变狭窄程度、病变部位和范围进行定量评定。按照全球急性冠状动脉事件注册(GRACE)风险评分分为低危组(74例)、中危组(64例)和高危组(14例)。检测各组患者血清H-FABP和hs-cTnI水平,比较并分析两者与冠脉病变程度及危险分层。结果 STEMI组、NSTEMI组和UAP组H-FABP检测结果差异间存在显著性(μg/L:42.9±21.9、16.9±10.2、9.8±4.6,均P<0.05);STEMI组和NSTEMI组hs-cTnI检测结果均明显高于UAP组[μg/L:5.25(0.06~32.6)、3.25(0.01~18.6)比0.02(0.01~0.3),均P<0.05]。在STEMI+NSTEMI组中,随着患者冠脉狭窄程度、病变支数及Gensini积分的增加,H-FABP呈逐步上升的趋势;高危组H-FABP、hs-cTnI结果均显著高于中危组和低危组[H-FABP(μg/L):32.7±13.3比22.3±8.1、7.1±5.3;hs-cTnI(μg/L):12.4(4.13~20.90)比1.28(0.06~6.25)、0.02(0.01~0.41)],且组间差异均具有统计学意义(均P<0.05)。结论 H-FABP、hs-cTnI与ACS患者冠脉病变严重程度密切相关,对临床判断病变程度、评估危险分层并采取积极治疗措施具有一定意义。

Objective To investigate the significance of high-sensitivity troponin I （ hs-cTnI ） and heart fatty acid binding protein （ H-FABP ） on severity of coronary lesions and risk stratification in patients with acute coronary syndrome （ ACS ） . Methods 152 Patients with ACS admitted to Ruijin Hospital, Shanghai Jiaotong University School of Medicine were enrolled and were divided into UAP group （ 24 patients, 16% ）, STEMI group （ 72 patients, 47% ） and NSTEMI group （ 56 patients, 37% ） according to diagnostic criteria of ACS . The gensini integral system was used to quantitatively evaluate the severity, location and extent of coronary artery stenosis according to the coronary artery image integral segmentation evaluation criteria based on the American heart disease association （ ACC ）. 152 patients were classified into 3 groups ： low risk group （ 74 cases ）, average risk group （ 64 cases ） and high risk group （ 14 cases ） by the global registry of acute coronary events （ GRACE ） risk score . Serum concentrations of H-FA1BP, hs-cTnI were determined . The correlation between the degree of coronary lesion and risk stratification was compared and analyzed . Results There were significant differences in the results among STEMI, NSTEMI and UAP groups （μg/L： 42.9±21.9, 16.9±10.2, 9.8±4.6, all P 〈 0.05 ）. The results of hs-cTnI in STEMI and NSTEMI groups were significantly higher than that in UAP group [μg/L ： 5.25 （ 0.06-32.6 ）, 3.25 （ 0.01-18.6 ） vs. 0.02 （ 0.01-0.3 ）, all P 〈 0.05]. In the STEMI＋NSTEMI groups, H-FABP were increased gradually with the increase of the degree of coronary stenosis, the number of lesions and the number of gensini integrals. The results of H-FABP, hs-cTnI in high risk group were significantly higher than those in low-risk group and average risk group [H-FABP （μg/L ） ： 32.7±13.3 vs. 22.3 ±8.1, 7.1 ± 5.3; hs-cTnI （μg/L ） ： 12.4 （ 4.13-20.90 ） vs. 1.28 （0.06-6.25）, 0.02 （ 0.01-0.41 ）] and the differences among groups were significant （all P 〈 0.05） . ConehlsiOns H-FABP, hs-cTnI were closely related to the severity of coronary lesions in patients with acute coronary syndrome, and it is of some significance to evaluate the degree of clinical lesion, assess risk stratification and take active treatment measures.