心肌型脂肪酸结合蛋白早期快速诊断OPCAB术后心肌梗死

目的 探讨心肌型脂肪酸结合蛋白(H-FABP)对非体外循环不停跳冠状动脉旁路移植术(OPCAB)术后心肌梗死的早期快速诊断价值.方法 2009年3月至7月,59例患者行首次单纯OPCAB.根据围手术期肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(cTnI)值及心电图、超声心动图的变化将患者分为正常组(Ⅰ组)、心肌损伤组(Ⅱ组)和心肌梗死组(Ⅲ组),分析各组H-FABP、CK-MB、cTnI含量的变化,并应用ROC曲线分析H-FABP诊断术后急性心肌梗死的诊断截断点和应用价值.结果 Ⅲ组的H-FABP水平显著高于Ⅱ组及Ⅰ组(P＜0.01),H-FABP峰值出现时间早(人ICU 2 h即达到高峰),维持时间短(入ICU 4 h即开始下降),术后1天回到基线水平.经ROC曲线检验,以H-FABP 22μg/L为心肌梗死的诊断截断点,入ICU即刻诊断灵敏度为90.9％,特异性为77.1％.入ICU 2 h的H-FABP值灵敏度为72.7％,特异性为75.0％.结论 H-FABP有助于OPCAB术后心肌梗死的早期快速诊断.     

心脏型脂肪酸结合蛋白在急性心肌梗死早期诊断中的价值

目的探讨心脏型脂肪酸结合蛋白（H-FABP）在急性心肌梗死（AMI）早期诊断中的应用价值。方法检测60例疑似AMI患者H—FABP、心肌肌钙蛋白（cTn）T、肌酸激酶同工酶．MB（CK-MB）水平,按发病时间分为〈6h、6～12h两个时段,计算各项指标诊断AMI的灵敏度,同时测定15例非AMI疑似患者及45例健康体检者的H-FABP、cTnT、CK-MB水平,计算各项指标诊断AMI的特异度。结果H-FABP在发病〈6h诊断AMI的灵敏度为94％,明显优于cTnT的50％、CK-MB的56％,差异均有统计学意义（P〈0．05）;在发病6～12h,H—FABP诊断AMI的灵敏度为100％、cTnT为92％、CK-MB为92％,差异无统计学意义。三项指标诊断AMI的特异度比较差异无统计学意义。结论H—FABP对AMI早期诊断有较高的灵敏度和特异度,适用于胸痛患者的筛查及早期诊断AMI。     

心肌脂肪酸结合蛋白变化与OPCAB后心肌梗死

目的 探讨心肌型脂肪酸结合蛋白(H-FABP)与非体循环外冠状动脉旁路移植术(OPCAB)后心肌损伤及心肌梗死的关系.方法 59例首次单纯行OPCAB的患者,分别于麻醉诱导后、CABG手术结束(最后1支旁路血管吻合完毕)、入ICU即刻、2、4、8h及术后l天抽取中心静脉血检测H-FABP含量;于术前、入ICU 4、8h、术后1、2天分别常规化验cTnI、CK-MB.根据术后8h的cTnI值及心电图的改变将患者分为正常组(I组,cTnI＜0.1 ng/ml)、心肌损伤组(Ⅱ组,cTnI 0.1～ 1.0 ng/ml)、心肌梗死组(Ⅲ组,cTnI＞1 ng/ml).结果 心肌梗死组的H-FABP显著高于心肌损伤组及正常组(P＜0.01),H-FABP与cTnI、CK-MB有良好的相关性.H-FABP在入ICU 2 h达峰值,显著早于cTnI、CK-MB(P＜0.01),且入ICU 4 h即开始下降,术后1天回到基线水平.而cTnI、CK-MB达峰值的时间分别是术后8h和1天,且术后2天仍维持在较高水平.结论 H-FABP与OPCAB围手术期心肌梗死有良好的相关性,且与“金标准”cTnI比较具有一定的优越性,早期监测H-FABP对诊断围手术期心肌梗死具有较为突出的应用价值.     

心肌损害早期标志物的研究进展

寻求理想的血生物标记物诊断心肌损伤和心肌缺血是当今研究的热点,而理想的心肌生化标志物应具有靶细胞富集、合适的半衰期、高度心脏专一性等特征.目前已经有越来越多的心肌标志物在临床中得到应用,现就心肌损伤和心肌缺血早期标志物研究领域的最新进展作一综述.     

心肌损害早期标志物的研究进展

寻求理想的血生物标记物诊断心肌损伤和心肌缺血是当今研究的热点,而理想的心肌生化标志物应具有靶细胞富集、合适的半衰期、高度心脏专一性等特征.目前已经有越来越多的心肌标志物在临床中得到应用,现就心肌损伤和心肌缺血早期标志物研究领域的最新进展作一综述.     

肠脂肪酸结合蛋白和肌酸磷酸激酶在肠梗阻诊断中的意义

目的：探讨肠脂肪酸结合蛋白（IFABP）、肌酸磷酸激酶（CK）在肠梗阻诊断中的意义。方法：将27例肠梗阻患者分为两组：观察组1（手术发现肠坏死行肠切除、肠吻合术）12例,观察组2（行手术治疗发现无肠坏死者）15例,分别在入院时、术后第1d、术后第3d采静脉血,检测血标本中IFABP及CK的含量;正常体检者15例作为对照组,采静脉血1次。结果：两观察组入院时血清IFABP及CK水平均高于正常对照组;术后第1d,两观察组IFABP水平均降至正常,CK水平较术前无明显变化;术后第3d,两观察组IFABP水平与对照组无明显差别,而CK水平较前明显降低。结论：IFABP及CK是诊断肠缺血、肠坏死的敏感指标,且IFABP对肠梗阻术后的预后有指导意义。     

肠型脂肪酸结合蛋白对肠缺血早期诊断的意义

目的　探讨肠型脂肪酸结合蛋白 (IFABP)对肠缺血早期诊断的意义。方法　将SD大鼠随机分成对照组和肠系膜上动脉结扎组 (SMA组 ) ,分别于术前及术后 1,2 ,4h取血 ,检测各时点的血清IFABP、肌酸激酶 (CK )、肌酸激酶BB型同工酶 (CK BB)和乳酸脱氢酶 (LDH )。结果　对照组血清I FABP水平在各时点均无明显差异 (P >0 .0 5 )。SMA组结扎后 1h血清IFABP水平迅速增加 ,与对照组相比 ,差异具显著性 (P <0 .0 1) ;结扎 2h达高峰。血清中CK ,CK BB和LDH活性均随缺血时间的延长而出现升高趋势。与对照组相比 ,各组CK ,CK BB和LDH出现显著性升高的时间依次为缺血后1,2 ,4h(P <0 .0 5 )。结论　IFABP是小肠缺血性疾病的早期、特异、敏感的生化诊断指标。     

重型颅脑损伤患者心肌损害的早期诊断

目的 探讨重型颅脑损伤患者心肌损害的早期诊断及心脏型脂肪酸结合蛋白(h-FABP)对患者预后的影响.方法 血清h-FABP采用双抗体夹心酶联免疫一步法定量检测,cTnI采用固相酶联免疫吸附试验(ELISA),CK-MB采用免疫抑制法.结果 重型颅脑损伤患者组血清h-FABP、cTnI及CK-MB水平分别显著高于健康对照组(P<0.01),重型颅脑损伤患者血清h-FABP阳性率显著高于血清cTnI、CK-MB或心电图的阳性率(P<0.01),47例重型颅脑损伤患者治疗后死亡8例,病死率为17.02%(8/47),血清h-FABP、cTnI及CK-MB异常组的病死率显著高于正常组(P<0.01);重型颅脑损伤患者血清h-FABP预测发生死亡具有高的敏感性和阴性预测值,但特异性和准确度较低.结论 血清h-FABP定量测定作为一种对微小心肌损伤高敏感的指标,可作为判断重型颅脑损伤急性期病情轻重、评价发生意外的一项客观指标.     

心肌型脂肪酸结合蛋白是冠脉搭桥术后死亡和心室功能不全的独立预测因素

背景心肌型脂肪酸结合蛋白（heart-typefattyacidbindingprotein,hFABP）作为心肌脂肪酸的转运体,在心肌损害的早期即可释放入血。我们假设hFABP可用于早期预测冠脉搭桥术围术期心肌损害的发生,其敏感性更优于传统的心脏生物标志物。方法本研究为前瞻性队列研究,共纳入两家医疗机构体外循环下行冠脉搭桥术（coronaryarterybypassgraft,CABG）的患者1298例。在围术期的7个不同时点分别检测了血浆中的4种心肌损害标志物：hFABP、肌钙蛋白Ⅰ、心肌型肌酸激酶同工酶MB（creatingkinaseMB,CK-MB）以及肌红蛋白。采用Cox比例风险模型,评价围术期心肌标志物水平与心室功能不全、住院时间以及术后5年死亡率（时间中位数3．3年）的相关性。患者住院期间心室功能不全定义：需要新增加2种或以上的强心药物治疗、安置新的主动脉内球囊反搏、需要在术中停止体外循环时或者术后在监护室中使用心室辅助装置。结果hFABP对于心脏手术患者死亡率的阳性和阴性预测值分别为13％（95％可信区间,9％。19％）和95％（95％可信区间,94％-96％）,高于肌钙蛋白Ⅰ和CK．MB。将其作为临床预测因素进行校正后,术后第1天hFABP水平及其峰值水平均是冠脉搭桥术后心室功能不全（P〈0．0001）、住院时间延长（P〈0．05）和5年死亡率增加（P〈0．0001）的独立预测因素。另外,术后第1天hFABP水平及其峰值水平在预测患者死亡率时显著优于研究纳入的其他生物标志物。在重复测量方差分析中,hFABP与其他拟合模型相比能更好的预测患者住院时间。术后第2天hFABP高于停止体外循环时水平的患者,其死亡率显著高于术后第2天hFABP低于停止体外循环时水平的患者（风险比,10．9;95％可信区间,5．0-23．7;P=7．2×10^-10）。出现延迟性hFABP峰值的120例患者（占患者总人数的10％）的死亡率为18．3％,未出现延迟性hFABP峰值患者的死亡率仅为4．7％。而是否出现肌钙蛋白Ⅰ和CK-MB的延迟峰值对患者死亡率无显著影响。结论与冠脉搭桥术后传统的心肌损伤标志物相比较,hFABP在CABG术后早期可达峰值,是一种更具优势的患者术后死亡和心室功能不全的独立预测因素。     

Heart-type fatty acid binding protein (hFABP) in the diagnosis of myocardial damage in coronary artery bypass grafting

Objectives: Heart-type fatty acid binding protein (hFABP) is an intracellular molecule engaged in the transport of fatty acids through myocardial cytoplasm and has been used as a rapid marker of myocardial infarction. However, its value in the evaluation of perioperative myocardial injury has not yet been assessed. Methods: 32 consecutive patients undergoing coronary artery bypass grafting were included in a prospective, randomized study using standardized operative procedures and myocardial protection. Three patients with perioperative myocardial infarction were added. Serial blood samples were taken preoperatively, before ischemia, 5 and 60 min after declamping, 1 and 6 h postoperatively and on postoperative days 1, 2 and 10 and were tested for hFABP, creatin kinase isoenzyme MB (CKMB) and troponin I (TnI). Results: Hospital mortality was zero. The kinetics of the biochemical parameters revealed a typical pattern for each marker. In routine patients, hFABP levels peaked as early as 1 h after declamping, whereas CKMB and TnI peaked only 1 h after arrival in the intensive care unit. Patients with perioperative infarction displayed peak levels some hours later in all marker proteins. Peak serum levels of hFABP correlated significantly with peak levels of CKMB (r=0.436, P=0.011) and TnI (r=0.548, P=0.001), indicating the degree of myocardial damage. Conclusions: hFABP is a rapid marker of perioperative myocardial damage and peaks earlier than CKMB or TnI. The kinetics of marker proteins in serial samples immediately after reperfusion is more suitable for the detection of perioperative myocardial infarction than a fixed cut-off level.     

Urinary excretion of liver fatty acid-binding protein in health-check participants

Background Messenger RNA of liver fatty acid-binding protein (L-FABP) is expressed in proximal tubules of the kidney, and a certain amount is excreted into urine. We analyzed factors relating to the urinary L-FABP excretion in health-check participants.Methods We measured L-FABP in the first morning urine by ELISA in 715 men and 193 women 30–79 years of age who entered a 2-day hospitalized health checkup program. In addition to the routine physical examination and laboratory tests, plasma high-sensitivity C-reactive protein (HSCRP) was assayed.Results In 150 healthy subjects, urinary L-FABP averaged 3.6 ± 0.2µg/g creatinine, whereas the values were significantly increased in patients with hypertension (5.2 ± 0.4, P = 0.010), diabetes mellitus (5.5 ± 0.5, P < 0.001), and chronic hepatitis (5.8 ± 1.0, P = 0.022). Urinary L-FABP excretion was significantly greater in women than in men when the value was related to creatinine. In regression analysis in men, urinary L-FABP was positively correlated with fasting plasma glucose (r = 0.103, P = 0.033) and plasma HSCRP (r = 0.135, P = 0.006).Conclusions It is suggested that renal production and urinary excretion of L-FABP are increased in situations in which arteriosclerosis is promoted, such as hypertension, diabetes mellitus, and cardiovascular inflammation.     

Diagnostic value of intestinal fatty acid-binding protein for pneumatosis intestinalis

Background

Pneumatosis intestinalis (PI) is known as a sign of a life-threatening bowel ischemia. We aimed to evaluate the utility of intestinal fatty acid-binding protein (I-FABP) in the diagnosis of pathologic PI.

Methods

All consecutive patients who presented to our emergency department with PI were prospectively enrolled. The diagnostic performance of I-FABP for pathologic PI was compared with that of other traditional biomarkers and various parameters.

Results

Seventy patients with PI were enrolled. Pathologic PI was diagnosed in 27 patients (39%). The levels of most biomarkers were significantly higher in patients with pathologic PI than those with nonpathologic PI (P < .05). Receiver operator characteristic analysis revealed that the area under the curve (AUC) was highest for I-FABP (area under the curve = .82) in the diagnosis of pathologic PI.

Conclusions

High I-FABP value, in combination with other parameters, might be clinically useful for pathologic PI.     

脊髓损伤后热休克蛋白27、表皮脂肪酸结合蛋白和金属蛋白酶组织抑制因子-1的基因表达及甲基强的松龙对其表达的影响

目的研究脊髓损伤后热休克蛋白27(HSP27)、表皮脂肪酸结合蛋白(FABPs)和金属蛋白酶组织抑制因子-1(TIMP-1)的基因表达及甲基强的松龙(MP)对其表达的影响.方法SD大鼠30只.随机分为假手术组、单纯脊髓损伤组(损伤组)及脊髓损伤+大剂量MP治疗组(MP组),每组10只.应用改良的Allen's打击法致T8脊髓损伤.MP组大鼠伤后即刻从尾静脉内注射大剂量MP(30mg/kg).损伤后24h切取损伤平面上下0.5cm的脊髓组织,进行RT-PCR反应,检测HSP27、FABPs和TIMP-1的基因表达.结果术后24h假手术组HSP27、FABPs和TIMP-1的基因表达相对丰度分别为0.0643±0.0152、0.6413±0.1005和0.7091±0.0577;损伤组上述三个因子的表达升高,分别为1.0013±0.3861、1.2187±0.2851和0.8971±0.1092,与假手术组比较差异有显著性(P＜0.01、P＜0.05、P＜0.05);MP组上述三个因子的表达继续升高,分别为1.2858±0.1384、1.7122±0.1766和1.2081±0.1093,与损伤组比较差异有显著性(P＜0.05、P＜0.01和P＜0.01).结论脊髓损伤后,邻近损伤处的脊髓组织中HSP27、FABPs及TIMP-1的基因表达显著增高,大剂量MP能进一步促进三个因子表达,发挥组织保护作用.     

Urinary intestinal fatty acid-binding protein concentration predicts extent of disease in necrotizing enterocolitis

Purpose

Urinary intestinal fatty acid-binding protein (i-FABP), a marker of intestinal mucosal cell damage, has recently been proposed as a clinically useful measure in the early detection of necrotizing enterocolitis (NEC). However, there are no data on urinary i-FABP in more advanced (Bell stage II /III) NEC. The aim of this study was to test the use of urinary i-FABP in surgical NEC.

Methods

Urine was collected every 24 hours from infants with Bell stage II/III NEC admitted to a surgical Neonatal Intensive Care Unit. Clinical, laboratory, and surgical data were collected concurrently. Urinary i-FABP was quantified by enzyme-linked immunosorbent assay and expressed as picograms per nanomole creatinine (median [range]). Results are presented as median (range) and compared by Mann-Whitney test and by linear regression.

Results

There was a trend toward an increase in i-FABP:Cr in infants with NEC (controls, 1.0 [0.4-1.3], vs NEC, 2.1 [0.39-35.1], P = .055). Urinary i-FABP:Cr was significantly higher in infants with extensive disease (7.4 pg/mmol [2.1-35.0 pg/mmol]) than in those with focal disease (1.1 pg/mmol [0.3-1.7 pg/mmol]), P = .002. In addition, i-FABP:Cr was less than the previously suggested 2 pg/mmol cutoff in 6 of 16 infants with NEC, 5 of whom had focal disease. Urinary i-FABP:Cr decreased during both successful nonoperative management (P < .0001) and after surgery in the operated group.

Conclusions

In this pilot study, urinary i-FABP was associated with extensive disease in infants with NEC requiring surgery. Further work, in a larger number of patients, is required to investigate the applicability of urinary i-FABP as a marker of intestinal damage and as an adjunct to current indications for surgical intervention in infants with NEC.     

多不饱和脂肪酸衍生物对急性肺损伤的保护作用研究进展

背景急性肺损伤（acute lung injury,ALI）是目前严重威胁人类健康的疾病之一。有大量研究表明：源自多不饱和脂肪酸（polyunsaturated fatty acids,PUFA）的一些特殊的促炎症消退介质（specialized pro-resolving mediators,SPM）对ALI具有一定的保护作用。目的分析总结SPM对ALI的保护作用和机制。内容此文描述SPM的分子生物学特征、炎症与ALI的关系,SPM的抗炎和促进炎症消退的保护作用及机制3个方面。趋向SPM对ALI具有一定的保护作用,这对于临床上治疗ALI提供了一种新的思路和方法。