HFABP在心脏直视手术后心肌损伤中的早期诊断价值

EARLY DIAGNOSIS OF MYOCARDIAL DAMAGE WITH HEART FATTYACID-BINDING PROTEIN AFTER OPEN HEART SURGERY

目的 探讨心脏脂肪酸结合蛋白 (Heartfattyacid -bindingprotein ,HFABP)对心脏直视手术后心肌损伤的判定价值。方法 2 0例行心脏直视手术的先心病人随机分为两组 ;Ⅰ组 (冷晶体停搏液组 ) ,Ⅱ组 (冷晶体停搏液中加入磷酸肌酸钠 ) ,每组 1 0例 ,分别于围术期多个时点取桡动脉血 ,测定血浆HFABP、cTnI、CK -MB的水平。结果 术前两组病人的血浆HFABP、cTnI、CK -MB的水平无明显差异。血浆HFABP于再灌注后最早达峰值 ,Ⅱ组血浆HFABP、cTnI、CK -MB的水平分别于再灌注后 1 / 2h、6h、2h明显低于Ⅰ组P <0 0 1 ) ,血浆HFABP峰值与cTnI、CK -MB的峰值及主动脉阻断时间呈正相关。结论 HFABP判定心脏直视手术后心肌损伤的早期诊断价值优于cTnI、CK -MB ,对于围术期心肌损伤的诊断。

Objective To assess the clinical value of heart fatty acid-binding protein(HFABP)in the diagnosis of myocardial damage after open heart surgery.Methods Twenty patients with congenital heart defect who underwent cardiac operations with CPB were randomly divided into two groups group Ⅱ (cold crystalloid cardioplegia with creatine phosphate,n=10),group Ⅰ (cold crystalloid cardioplegia,n=10).The radial arterial blood samples were serially collected after reperfusion to measure plasma levels of HFABP,creatine kinase-MB(CK-MB)and cardiac troponin-Ⅰ(cTnI).Results Plasma HFABP,CK-MB and cTnl levels were not obviously different before operation in the two groups.Plasma HFABP levels peaked earliest after reperfusion.The plasma HFABP,CK-MB and cTnl levels were significantly lower in group Ⅰ than those in group Ⅱ 1/2h,2h and 6h after reperfusion,respectively(P<0.01).In addition,the maximum plasma HFABP level was predictable immediately after reperfusion.The maximum plasma HFABP level correlated with the maximum plasma CK-MB or cTnl level,as well as with the aortic cross-clamp time.Conclusion HFABP can be used to evaluate the degree of myocardial damage and myocardial protective effect in open heart surgery during CPB.Measurements of HFABP allow for earlier evaluation of myocardial damage in the acute phase of reperfusion than CK-MB,cTnl.And they may be regarded as indicators of the myocardial damage.