血清H-FABP和NT-proBNP对过敏性紫癜患儿心肌缺血状态的评估价值

Evaluation value of serum H-FABP and NT-proBNP in myocardial ischemia in children with allergic purpura

目的探讨血清心肌型脂肪酸结合蛋白(H-FABP)和N-末端脑钠肽前体(NT-pro BNP)对过敏性紫癜患儿心功能状态的评估价值。方法收集本院2014年1月至2017年1月期间过敏性紫癜患儿65例为研究对象,记录患儿心率、H-FABP和NT-pro BNP水平、心电图以及患儿是否合并先天性心脏疾病以及心肌钙蛋白I(c TnⅠ)、肌酸激酶同工酶(CK-MB)水平,并根据心肌损伤发生的时间分为≤6 h、6~12 h和≥12 h组。结果共21例发生心肌损伤,发生率为32.31%(21/65),心肌损伤组患儿血清H-FABP和NT-pro BNP和心肌酶谱c TnⅠ、CK-MB均明显高于非心肌损伤组,差异有统计学意义(P<0.05);心肌损伤≤6 h时血清H-FABP升高最为明显,6~12 h后亦进一步升高,组间比较差异有统计学意义(P<0.05);校正是否合并先天性心脏病、心率、以及c TnⅠ和CK-MB水平等因素,多变量Logistic回归分析显示,血清H-FABP每升高20 pg/m L,心肌损伤发生风险增加2.36倍(OR=2.351,95%CI:1.461~3.753),而NT-pro BNP未见统计学意义(P>0.05)。ROC曲线显示,过敏性紫癜患儿的H-FABP和NT-pro BNP的预测值AUC为0.922和0.865。结论血清H-FABP在过敏性紫癜患儿疾病早期即出现明显变化,可作为患儿早期心肌缺血状态的诊断标记物。

Objective To evaluate the value of serum heart fatty acid binding protein（H-FABP）and N-terminal pro-brain natriuretic peptide（NT-pro BNP）in myocardial ischemia in children with allergic purpura. Methods 65 children with allergic purpura were selected. The heart rate,H-FABP,NT-pro BNP,cardiac troponinⅠ（c TnⅠ）and creatine kinase isoenzyme（CK-MB）levels,and whether children with congenital heart disease were recorded. According to the time of the myocardial injury,the children were divided into ≤ 6 h,6-12 h and ≥ 12 h groups. Results There were a total of 21 cases of myocardial injury,with the incidence of 32.31%. In the myocardial injury group,the serum levels of H-FABP,NTpro BNP,c TnⅠ and CK-MB were significantly higher than those of the group without myocardial injury（P〈0.05）. When the myocardial injury was ≤ 6 h,the serum H-FABP level was increased most obviously,and it increased further after 6-12 hours（P〈0.05）. Correction combination of congenital heart disease,heart rate,and c TnⅠ and CK-MB level factors,multivariate logistic regression analysis showed that higher serum H-FABP level for every 20 pg/mL,a 2.36-fold increased risk of myocardial injury（OR=2.351,95%CI：1.461-3.753）,but the NT-pro BNP level was not statistical significance（P〈0.05）. The ROC curve showed that the predictive value of H-FABP and NT-pro BNP levels in children with allergic purpura were 0.922 and 0.865,respectively. Conclusion Serum H-FABP level in children with allergic purpura had a significant change,and could be used as the markers of the children with early myocardial ischemia.