心脏型脂肪酸结合蛋白在急性心梗早期诊断中的临床意义

目的探讨血浆心脏型脂肪酸结合蛋白)H-FABP)在急性心肌梗死(AMI)早期诊断中的临床意义。方法选择因胸痛就诊被确诊为急性心肌梗死患者35例,采用免疫胶体金渗透方法定性检测对照组和患者发病3 h内和12 h后血浆的H-FABP,同时测定心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB),并进行比较。结果H-FABP对AMI发病3 h内的诊断阳性率为90.2%,与其他两项指标比较有统计学差异(P<0.05);而在发病12 h后阳性率为12.3%,明显低于另两项指标。结论H-FABP对于诊断早期AMI具有较高的敏感性和特异性,优于cTnI、CK-MB。     

心肌型脂肪酸结合蛋白在急性心肌梗死早期诊断中的比较优势

心肌梗死后从冠状动脉急性闭塞至心肌透壁性坏死大约为6h ,在该时间窗内使冠状动脉再通,可挽救濒临坏死的心肌[1 ] 。有1/3以上AMI患者缺乏典型症状,而传统的心电图诊断敏感性仅约46%。1999年ESC和ACC联合建议将检测到心肌标志物的异常变化作为诊断MI急性发病的必要条件[2 ] 。近年来心肌型脂肪酸结合蛋白(H -FABP)因较好地符合IFCC心肌损伤标志物标准化委员会规定的理想标志物所应具备的四个条件而倍受关注[3 ] 。本文通过H -FABP与肌红蛋白(Myo globin ,Mb)、CK -MB、cTNI等传统标记物相比较,论述该指标在AMI早期诊断中的…     

心脏型脂肪酸结合蛋白在急性心肌梗死早期诊断中的临床意义

目的 通过连续测定急性心肌梗死(AMI)患者血浆心脏型脂肪酸结合蛋白(H-FABP)水平,探讨其在AMI早期诊断中的意义。方法 采用固相夹心酶联免疫法测定46例AMI患者在发病后30 min、1h、2h、4h、6h及12 h血浆H-FABP水平,同时测定心肌肌钙蛋白Ⅰ(cTnⅠ)和肌酸激酶同工酶MB (CK-MB)水平,比较三种心肌损伤标志物诊断AMI的准确率。结果 AMI发病时间≤6 h,H-FABP诊断AMI的准确率[95.7％ (44/46)]明显高于cTnⅠ[65.2％(30/46)]和CK-MB [41.3％(19/46)],差异有统计学意义(P＜0.05)。H-FABP在AMI发病后4h即显著升高,cTnⅠ在AMI发病后6h显著升高,CK-MB在AMI发病后12h显著升高。结论 H-FABP在AMI诊断中具有较高的准确率,可作为AMI早期诊断的指标。     

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<6 h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6～12 h,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.     

心型脂肪酸结合蛋白在急性心肌梗死早期诊断中的应用

目的探讨心型脂肪酸结合蛋白在急性心肌梗死早期诊断中的应用价值。方法选择在胸痛发作3h以内就诊的患者150例,分别于胸痛发作0~3h、3~6h和6~12h检测血清心型脂肪酸结合蛋白(hearty fatty acid binding protein,H-FABP)、心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnI)、肌酸激酶同工酶(creatine kinase isoenzyme MB,CK-MB)和肌红蛋白(myoglobin,MYO)的水平变化,并比较4种心肌标志物诊断早期AMI的敏感性、特异性、阳性预测值和阴性预测值,同时比较胸痛患者发作≤8h时不同心肌标志物联合诊断AMI的敏感性和特异性。结果 AMI患者在胸痛发作3个时间段内血清H-FABP水平均明显高于非AMI组和对照组(P<0.05),非AMI组与对照组差异无统计学意义(P>0.05)。胸痛患者发作0~3 h内H-FABP的敏感性、阳性预测值、阴性预测值均比cTnI、CKMB和MYO高(P<0.05);3~6 h内H-FABP的敏感性、特异性在4者当中最高(P<0.05)。胸痛发作≤8 h,HFABP+cTnI+MYO联合检测对AMI早期诊断的敏感性最高(94.1%)。结论 H-FABP对于诊断早期AMI具有较高敏感性和良好的特异性,在早期AMI诊断方面是一项具有巨大潜力的生化心肌标志物。胸痛发作≤8 h时,HFABP+cTnI+MYO联合检测可进一步提高AMI早期诊断的敏感性,优于传统的cTnI+CK-MB+MYO联合检测。     

脂肪酸结合蛋白在肠道疾病中的应用

肠道脂肪酸结合蛋白(FABP)有肠型和肝型两种.目前正广泛被应用于肠道损伤性疾病,如肠缺血的早期诊断.现就肠道FABP的特点和应用作一综述.     

心脏型脂肪酸结合蛋白在急性心肌梗死早期诊断的价值

目的研究心脏型脂肪酸结合蛋白(H-FABP)对急性心肌梗死早期诊断的价值。方法 90例早期胸痛患者分别进行H-FABP检测和常规实验室方法测cTnI和CK-MB,比较不同检测方法的诊断敏感性及特异性。结果 H-FABP检测的诊断敏感性及准确性均明显高于常规的检测(P<0.05)。结论 H-FABP对于急性心肌梗死的早期诊断具有较高的敏感性及特异性,可作为诊断早期急性心肌梗死的参考指标。     

心型脂肪酸结合蛋白测定在急性心肌梗死诊断中的价值

目的探讨心型脂肪酸结合蛋白在急性心肌梗死诊断中的的应用价值。方法选择2013年4月—2014年7月东南医院确诊为急性心肌梗死的82例患者为研究对象,根据发病时间分为0~3 h组、3~6 h组和6 h以上组,选择30例同期健康体检者为对照组。所有纳入对象均进行心型脂肪酸结合蛋白、肌酸激酶和肌酸激酶同工酶浓度水平检测,并结合心电图检查结果进行比较分析。结果与对照组比较,0~3 h组、3~6 h组和6 h以上组患者心型脂肪酸结合蛋白浓度水平明显增高,差异有显著性(P<0.05);3~6 h组和6 h以上组患者的肌酸激酶和肌酸激酶同工酶水平有显著增高,差异有显著性(P<0.05),但0~3 h组患者的肌酸激酶和肌酸激酶同工酶浓度水平无显著变化(P>0.05)。分析阳性检出率发现,0~3 h组和3~6 h组患者的心型脂肪酸结合蛋白阳性检出率(82.76%和84.62%)显著高于对照组,两两分别比较差异均有统计学意义(P<0.05),但6 h以上组患者无显著差异(P>0.05)。结论心型脂肪酸结合蛋白可以作为诊断急性心肌梗死疾病的良好指标,对出现早期心肌缺血患者的辅助诊断具有重要的临床价值。     

心型脂肪酸结合蛋白在冠心病中的临床应用

心型脂肪酸结合蛋白(heart-type fatty acid-binding protein,H-FABP)是近年来倍受关注的急性心肌损伤早期监测的生化标志物,诊断时间窗早、特异度高的特性,使其在黄金时间窗内较经典心肌损伤标志物对诊断和治疗更具优越性。H-FABP具有独特的生物学特性,目前多采用胶体金免疫层析技术研制出的定性试剂盒进行检测。H-FABP不仅可用于早期急性心肌梗死检测、梗死面积评估,尤其在早期急性心肌梗死的诊断中有其独特的优势。     

尿心肌型脂肪酸结合蛋白对急性心肌梗死的诊断价值

心肌型脂肪酸结合蛋白(H -FABP)是存在于心肌细胞胞浆内的可溶性低分子蛋白(分子量14kD～16kD) ,正常血浆和尿中不含H -FABP或极少存在。当心肌受损时,H -FABP从心肌细胞释放,快速进入血循环,从而引起血浆中浓度升高,因其在心肌受损后出现时间早、特异性高、敏感性高,近来年作为急性心肌梗死(AMI)的早期生化标志物而引起重视[1 ] 。它主要经过肾脏排泄[2 ] ,当心肌细胞受损时,尿中H -FABP也明显高于正常,故尿H -FABP对AMI的早期诊断也有意义。目前对血H -FABP的研究较多,而对尿H -FABP的研究较少,本文将对尿H -FABP对早期AMI的诊断价值进行综述。1　尿H -FABP与血H -FABP的比较H -FABP是低分子可溶性蛋白,在心肌细胞受损时可快速释放入血和尿中[3 ] ,血H -FABP主要从肾脏排出的。在Sohmia等[4] 对狗进行缺血-再灌注的实验研究中,发现血浆H -FABP到达峰值的时间仅为2 0～40min ,尿H -FABP达到峰值时间为45～75min ,而在人心脏手术中,再灌注后半小时,血浆中浓度明显增高,1h后达到峰值[4] ,王太重等也...     

组氨酸脱羧酶、肠道脂肪酸结合蛋白和二胺氧化酶在肠梗阻患者肠黏膜损伤诊断中的价值

目的 探讨血清组氨酸脱羧酶(HDC)、肠脂肪酸结合蛋白(I-FABP)和二胺氧化酶(DAO)在肠梗阻患者肠黏膜损伤(IMI)诊断中的应用价值.方法 采用酶联免疫吸附法检测HDC、I-FABP和DAO在28例绞窄性肠梗阻患者、19例单纯性肠梗阻患者、17例急性单纯性阑尾炎患者治疗前和20名健康对照者血清中的表达水平,并对其受试者工作特征(ROC)曲线下面积(AUC)进行比较;观察3组患者全身炎症反应综合征(SIRS)和感染并发症发生情况,并比较各诊断指标在其中的表达差异及与SIRS和感染并发症的相关性.结果 血清中HDC、I-FABP和DAO的表达水平均在绞窄性肠梗阻组中最高,明显高于其他3组(P均<0.001),3种指标的表达水平在单纯性肠梗阻组亦明显高于急性单纯性阑尾炎组和正常对照组(P均<0.05).HDC的AUC为0.913,大于I-FABP及DAO的0.877(P=0.000)和0.873(P=0.000).当HDC的临界值≥31.00 ng/ml时,其灵敏度为74.5%,特异度为94.6%,假阴性率为25.5%,假阳性率为5.4%,均优于I-FABP和DAO.绞窄性肠梗阻组、单纯性肠梗阻组及急性单纯性阑尾炎组的SIRS(P=0.046)和腹腔感染(P=0.027)发生率差异有统计学意义,而肺部感染发生率在3组患者中差异无统计学意义(P=0.728).血清HDC在绞窄性肠梗阻组的SIRS(P=0.000)和腹腔感染(P=0.002)患者中表达水平均显著高于未感染患者,血清I-FABP(P=0.027)及DAO(P=0.017)在绞窄性肠梗阻组的SIRS患者中表达水平均高于未感染患者.HDC、I-FABP及DAO的表达水平与SIRS及腹腔感染显著相关(P均<0.05),其中HDC与SIRS相关性最高(R=0.608,P=0.001).结论 血清HDC是一种有效的诊断肠梗阻患者IMI的生物学指标.

Abstract：

Objective To investigate the clinical values of serum histidine decarboxylase(HDC),intestinal fatty acid binding protein(I-FABP),and diamine oxidase(DAO)for diagnosing intestinal mucosal injury (IMI)in patients with intestinal obstruction.Methods The expression levels of serum HDC,I-FABP,and DAO in 28 patients with strangulated intestinal obstruction,19 patients with simple intestinal obstruction,17 patients with acute simple appendicitis,and 20 healthy control were determined by enzyme-linked immunosorbent assay (ELISA)before clinical treatment,and then the areaa under receiver operating characteristic curves(AUC)of these diagnostic indicators were compared.In addition,the incidences of systemic inflammatory response syndrome (SIRS)and infectious complications were closely observed.The difference of the expressions of HDC,I-FABP,and DAO and their relationship with SIRS and infectious complications were compared among these patients and controls.Results The expression levels of serum HDC, I-FABP, and DAO were the highest in patients with strangulated intestinal obstruction (all P < 0.001), and the expression levels of these three indicators were significantly higher in patients with simple intestinal obstruction than in those with acute simple appendicitis or healthy controls (all P<0.05).The AUC of HDC (0.913) was significantly larger than that of I-FABP (0.877, P =0.000) and DAO (0.873, P = 0.000).When the cut-off value of HDC ≥31.00 ng/ml, the sensitivity, specificity, false negative rate, and false positive rate of HDC were 74.5% , 94.6% , 25.5% , and 5.4% , respectively,which were all better than those of I-FABP and DAO.There were significant differences of the incidence of SIRS ( P = 0.046) and abdominal infection (P = 0.027) among patients with strangulated intestinal obstruction, patients with simple intestinal obstruction, and patients with acute simple appendicitis, while lung infection showed no such significant difference (P = 0.728).The expression level of serum HDC was significantly higher in patients with strangulated intestinal obstruction who were also suffered from SIRS ( P = 0.000) or abdominal infection ( P =0.002) than that of uninfected patients.Meanwhile, the expression levels of serum I-FABP and DAO were significantly higher in the SIRS patients with strangulated intestinal obstruction than that of uninfected patients ( P = 0.027, P=0.017, respectively).The expression levels of HDC, I-FABP, and DAO were significantly correlated with the incideces of SIRS and abdominal infection ( all P < 0.05 ) , among which the level of HDC and the incidence of SIRS had the highest correlation (R = 0.608, P = 0.001).Conclusion HDC can be an effective indicator for diagnosing IMI in patients with intestinal obstruction.     

心型脂肪酸结合蛋白对急性心肌梗死患者早期心功能参数评价价值

目的 探讨血清心型脂肪酸结合蛋白（H-FABP）水平与急性心肌梗死（AMI）患者部分心功能指标的相关性,为预防及早期发现急性心肌梗死提供依据。方法 以2015年5月至2017年5月在自贡市某医院进行治疗的AMI患者作为研究对象病例组,并以在同医院进行健康体检的无心血管疾病人群为对照组,对病例组发病后不同时间点和对照组人群H-FABP及主要心功能指标进行分析。结果 本研究共对124例AMI病例及124名无心血管疾病的健康体检者进行研究,2组人群男、女分别为69、55例,平均年龄和BMI差异均无统计学意义（均P>0.05）。发病后不同时间点（2、4、8、12、24 h）病例组H-FABP检测结果差异有统计学意义（P<0.01）,H-FABP在8 h前逐渐上升,于8 h达到最大值,其后逐渐降低。病例组在各时间点的H-FABP浓度均高于对照组（均P<0.01）。病例组发病后8 h时的左室射血分数（LVEF）、左室舒张未期内径（LVEDd）、血管舒张功能（FMD）均低于对照组（均P<0.01）,内皮细胞微粒（EMCs）检测值高于对照组（P<0.01）。Killip分级为Ⅱ、Ⅲ、Ⅳ级分别有43、39、42例,分别占34.7%、31.5%、33.9%。分级越高,H-FABP、LVEDd、EMCs检测值越高,LVEF和 FMD检测值越低,差异均有统计学意义（均P<0.01）。血清H-FABP水平与LVEF、FMD 水平呈负相关（b=-2.764、-2.846）,与EMCs、LVEDd水平呈正相关（b=2.294、2.495）。结论 H-FABP与AMI患者心功能参数具有较好的相关性,可作为早期评价心功能的指标。     

心型游离脂肪酸结合蛋白定性检查在急性非ST抬高心肌梗死超早期鉴别诊断中的应用

目的:探索心型游离脂肪酸结合蛋白在急性非ST抬高心肌梗死超早期(小于3 h)的应用价值。方法:选取2009年-2011年我院就诊的127名NSTEMI患者,以急诊PCI术中造影结果、冠状动脉CTA结果以及发病后3个月随访等信息作为最终诊断,在发病超早期内定性测定H-FABP及定量测定cTnI,并进行统计。结果:在本研究入组的患者中,H-FABP与cTnI相比具有较好的敏感性和特异性;联合H-FABP与cTnI两项结果进行诊断,其敏感度、特异性、阳性预测值及阴性预测值均较高。结论:H-FABP有望作为急性心肌坏死监测的一项快速、准确、敏感、特异性的指标。     

Role for fatty acid binding protein in the regulation of hepatic lipogenesis by dietary linoleic acid

The effect of added dietary ethyl palmitate or ethyl linoleate on hepatic lipogenic enzymes and the amount of hepatic fatty acid binding protein was examined in meal-fed rats. Dietary linoleate reduced the activities of fatty acid synthetase, glucose-6-phosphate dehydrogenase, NADP-malic enzyme, ATP-citrate lyase, and the amount of fatty acid binding protein compared to rats fed a fat-free or palmitate supplemented diet. The possible role of fatty acid biding protein in the regulation of lipogenesis by dietary fat is discussed.     

组氨酸脱羧酶、肠脂肪酸结合蛋白和二胺氧化酶在肠梗阻患者肠黏膜损伤诊断中的价值

Objective To investigate the clinical values of serum histidine decarboxylase(HDC),intestinal fatty acid binding protein(I-FABP),and diamine oxidase(DAO)for diagnosing intestinal mucosal injury (IMI)in patients with intestinal obstruction.Methods The expression levels of serum HDC,I-FABP,and DAO in 28 patients with strangulated intestinal obstruction,19 patients with simple intestinal obstruction,17 patients with acute simple appendicitis,and 20 healthy control were determined by enzyme-linked immunosorbent assay (ELISA)before clinical treatment,and then the areaa under receiver operating characteristic curves(AUC)of these diagnostic indicators were compared.In addition,the incidences of systemic inflammatory response syndrome (SIRS)and infectious complications were closely observed.The difference of the expressions of HDC,I-FABP,and DAO and their relationship with SIRS and infectious complications were compared among these patients and controls.Results The expression levels of serum HDC, I-FABP, and DAO were the highest in patients with strangulated intestinal obstruction (all P < 0.001), and the expression levels of these three indicators were significantly higher in patients with simple intestinal obstruction than in those with acute simple appendicitis or healthy controls (all P<0.05).The AUC of HDC (0.913) was significantly larger than that of I-FABP (0.877, P =0.000) and DAO (0.873, P = 0.000).When the cut-off value of HDC ≥31.00 ng/ml, the sensitivity, specificity, false negative rate, and false positive rate of HDC were 74.5% , 94.6% , 25.5% , and 5.4% , respectively,which were all better than those of I-FABP and DAO.There were significant differences of the incidence of SIRS ( P = 0.046) and abdominal infection (P = 0.027) among patients with strangulated intestinal obstruction, patients with simple intestinal obstruction, and patients with acute simple appendicitis, while lung infection showed no such significant difference (P = 0.728).The expression level of serum HDC was significantly higher in patients with strangulated intestinal obstruction who were also suffered from SIRS ( P = 0.000) or abdominal infection ( P =0.002) than that of uninfected patients.Meanwhile, the expression levels of serum I-FABP and DAO were significantly higher in the SIRS patients with strangulated intestinal obstruction than that of uninfected patients ( P = 0.027, P=0.017, respectively).The expression levels of HDC, I-FABP, and DAO were significantly correlated with the incideces of SIRS and abdominal infection ( all P < 0.05 ) , among which the level of HDC and the incidence of SIRS had the highest correlation (R = 0.608, P = 0.001).Conclusion HDC can be an effective indicator for diagnosing IMI in patients with intestinal obstruction.     

联合检测缺血修饰白蛋白、心肌型脂肪酸结合蛋白在急性心肌梗死患者中的应用价值

目的 探讨血清缺血修饰白蛋白(IMA)与心肌型脂肪酸结合蛋白(H-FABP)联合检测在急性心肌梗死(AMI)患者中的临床意义.方法 以急性胸痛患者90例为研究对象,检测血清IMA、H-FABP,根据AMI诊断标准分为AMI患者、非AMI患者,计算IMA、H-FABP及IMA+H-FABP对AMI诊断的诊断性试验评价指标.结果 AMI患者血清IMA、H-FABP明显高于非AMI患者及正常对照组(P＜ 0.01);IMA、H-FABP、IMA+H-FABP诊断AMI的敏感度分别为:89.5、93.7、100.特异度分别为:73.8、80.9、71.4.阴性预期值分别为:86.1、91.8、100.阳性预期值分别为:79.6、84.9、80.结论 IMA、H-FABP是诊断AMI的敏感指标,两者联合检测对AMI诊断价值更优.     

危重症患儿胃肠功能衰竭诊断指标价值的探讨

目的 探讨危重症患儿胃肠功能衰竭不同实验室诊断指标的价值.方法 76例危重症患儿,合并胃肠功能衰竭48例,测定其血浆D-乳酸、血清及尿液肠型脂肪酸结合蛋白(IFABP)浓度,筛选出对胃肠功能衰竭诊断有价值的指标,计算其灵敏度、特异度及ROC曲线下面积,比较其诊断价值.结果 血浆D-乳酸浓度≥9.63 mg/L,诊断危重症胃肠功能衰竭的灵敏度为85.2%,特异度为70.9%,ROC曲线下面积为0.822;血清IFABP浓度≥0.129μg/L,诊断危重症胃肠功能衰竭的灵敏度为65.2%,特异度为63.8%,ROC曲线下面积为0.744;尿液IFABP浓度≥0.330μg/L,诊断危重症胃肠功能衰竭的灵敏度为78.3%,特异度为72.3%,ROC曲线下面积为0.820.血清及尿液IFABP浓度ROC曲线下面积比较差异无统计学意义(P＞0.05);血浆D-乳酸浓度与血清IFABP浓度ROC曲线下面积比较差异无统计学意义(P＞0.05).结论 血浆D-乳酸、血清及尿液IFABP对危重症患儿胃肠功能衰竭有诊断价值,但血浆D-乳酸、尿液IFABP可能更适合于临床.     

Biomarqueurs entérocytaires et nutrition artificielle en réanimation

Early initiation of nutrition is required among critically ill patients hospitalized in the ICU. Enteral nutrition (EN) is the preferred route when the gut is presumed to be functioning but EN is associated with a risk of digestive intolerance which occurs in one half of the patients and which is associated with a poor prognosis. Evaluation of the small bowel function of critically ill patients hospitalized in the ICU is difficult. Plasma citrulline is a marker of functional enterocyte mass and plasma I-FABP is a marker of enterocyte damage. Plasma citrulline concentration is a validated biomarker of enterocyte mass among patients presenting with short bowel syndrome or with villous atrophy-associated diseases. I-FABP appears to be a promising biomarker of acute mesenteric ischemia. There is evidence that both biomarkers could be of interest among critically ill patients for the identification of small bowel damage or dysfunction. There is a two-way connection between enterocyte biomarkers and the route of nutrition. On the one hand, in the context of short bowel syndrome, plasma citrulline concentration appears to be a promising indicator for the evaluation of the tolerance of the enteral route and the possibility to wean parenteral nutrition. On the other hand, among critically ill patients, there is evidence that the route of nutrition modify the evolution of enterocyte biomarkers. Globally, it seems that, comparatively to PN, EN is associated with a more rapid increase of plasma citrulline concentration. This raises the question of a possible beneficial effect of EN over PN on the trophicity of the small bowel mucosa.