心肌型脂肪酸结合蛋白对发病早期肌钙蛋白阴性的冠状动脉综合征患者危险分层及预后评估

Clinical study of heart-type fatty acid binding protein for risk stratification and prognosis assessment of early cardiac troponin T-negative acute coronary syndrome patients

目的探讨早期检测心肌型脂肪酸结合蛋白T（H—FABP）对发病早期肌钙蛋白T（cTnT）阴性的冠状动脉综合征（ACS）患者的危险分层及预后评估中的价值。方法回顾性分析，55例早期cTnT阴性的ACS患者在出现临床症状后第6、12、24和48h连续动态监测H—FABP与cTnT水平。观察发病6h内H—FABP水平预测发病早期cTnT阴性的ACS患者心血管事件的受试者工作特征（R0c）曲线下面积，并依据ROC曲线选择H—FABP值合适的截断点，将患者分为H—FABP高值组11例与低值组44例，比较两组患者心血管事件发生情况及生存率的差异。结果出现临床症状6h内cTnT为阴性的ACS患者，随病情进展cTnT逐渐升高，在12h达峰值，然后开始下降；HFABP在出现症状6h内即达峰值，12h轻度下降，随后快速下降。出现症状6h内检测的H—FABP水平对发病早期cTnT阴性的ACS患者演变为心肌梗死预测的敏感度为87．5％，特异度为90．3％。在随访12个月时，发生心血管事件组患者的H—FABP水平高于无心血管事件组，[（38．08±8．43）μg／L与（18．96±2，85）μg／L（t=2．438，P〈0．05）]。ROC曲线分析显示曲线下面积为0．772，其预测心血管事件的截断值为44．71,ug／L。以该截断值为标准的高值组与低值组中，心血管事件的发生率分别为11．4％（5／44）和54．5％（6／11），差异有统计学意义（χ^2=10．256，P〈0．01）。结论发病早期cTnT检测阴性的ACS患者，H—FABP是危险分层与预后评估的良好指标。

Objective To examine the practical value of early detection of heart-type fatty acid binding protein （H-FABP）for risk stratification and prognosis assessment in cardiac troponin T （cTnT）-negative acute coronary syndrome （ACS）patients. Methods From March 2010 to March 2012,55 patients with chest pain and negative cTnT were selected from 232 ACS patients at the General Hospital of PLA. Expression levels of cTnT and H-FABP were detected within 6 h of the onset of clinical symptoms. H-FABP and cTnT values at 12,24, and 48 h from the onset of clinical symptoms were continuously measured to monitor the dynamic changes. Based on prognosis, patients were divided into two groups,levels of H-FABP were compared,and its predictive value for prognosis was assessed with the ROC curve. Results Within 6 h of the onset of clinical symptoms, cTnT levels in cTnT-negative ACS patients increased gradually as disease progressed and reached the peak value at 12 h before decreasing slowly and arriving at 50% of the peak value at 48 h. Meanwhile, H- FABP levels reached the peak within 6 h, decreased slightly （12.8%）at 12 h, and then decreased rapidly at 48 h （about 79%） .Of 55 patients, 24 had acute myocardial infarction during hospitalization. The H-FABP level within 6 h was a good predictor for cTnT negative ACS patients. The area under ROC curve was 0. 946 and the cutoff value was 15.47 μg/L. The prediction sensitivity was 87.5%,with a specificity of 90.3%. Eleven patients had cardiovascular events after a 12 month follow-up. Levels of H-FABP were different in patients with or without cardiovascular events, [ （ 38.08 ± 8.43 ）μg/L vs. （ 18.96 ± 2.85 ） μg/L （ t= 2. 438, P 〈0.05 ） ]. ROC curve analysis showed that the area under the curve was 0. 772 and the prediction cutoff value was 44.71 b^g/L. The rates of cardiovascular events were markedly different between patients with high（≥44.71μg/L）and those with low（〈44.71 μg/L）H-FABP levels（54.5% vs. 11.4%）. Conclusions For ACS patients with negative cTnT, H-FABP is a good index for early risk stratification and prognosis assessment.