Thrombolysis in patients with pulmonary embolism and elevated heart-type fatty acid-binding protein levels

Recent studies have reported that a novel cardiac biomarker, heart-type fatty acid-binding protein (h-FABP), significantly predicts mortality inpatients with pulmonary embolism (PE) at intermediate risk. The aim of this study was to evaluate the effect of thrombolytic therapy on prognosis of the intermediate risk acute PE patients with elevated levels of h-FABP. This is non-interventional, prospective, and single-center cohort study where 80 patients (mean age 62 ± 17 years, 32 men) with confirmed acute PE were included. Only patients with PE at intermediate risk (echocardiographic signs of right ventricular overload but without evidence for hypotension or shock) were included in the study. h-FABP and other biomarkers were measured upon admission to the emergency department. Thrombolytic (Thrl) therapy was administered at the physician’s discretion. Of the included 80 patients, 24 were h-FABP positive (30 %). 14 patients (58 %) with positive h-FABP had clinical deterioration during the hospital course and required inotropic support and 12 of these patients died. However, of 56 patients with negative test, only 7 patients worsened or needed inotropic support and five patients died during the hospital stay. Mortality of patients with PE at intermediate risk was 21 %. The 30-day mortality rate was significantly higher in h-FABP(+) patients compared to h-FABP(?) patients (9 vs. 50 %, p < 0.001). Multivariate analysis revealed h-FABP as the only 30 day mortality predictor (HR 7.81, CI 1.59–38.34, p = 0.01). However, thrl therapy did dot affect the survival of these high-risk patients. Despite, h-FABP was successful to predict 30-days mortality in patients with PE at intermediate risk; it is suggested to be failed in determining the patients who will benefit from thrl therapy.     

心型脂肪酸结合蛋白、肌钙蛋白I与急性冠脉综合征冠状动脉病变程度的相关分析

目的探讨心型脂肪酸结合蛋白(H-FABP)、肌钙蛋白I(cTnI)与近期发作急性冠脉综合征(ACS)的患者冠状动脉病变严重程度的相关性及原因分析。方法ACS患者于发作12h内入院,1周内行冠脉造影者98例入选,其中急性心肌梗死(AMI)21例、不稳定型心绞痛(UAP)77例。采用双抗体夹心ELISA法定量测量待测血清H-FABP、cTnI;根据美国心脏病协会所规定的冠状动脉血管图像记分分段评价标准,对病变狭窄程度进行分度、累及血管支数计算,采用Gensini积分系统,对冠脉血管病变狭窄程度、病变部位、范围进行定量评定;用卡方检验分析血H-FABP、cTnI与狭窄程度、病变支数的相关性;采用二元回归分析方法分析血清H-FABP、cTnI与患者冠状动脉病变严重程度的相关性。结果H-FABP≥8.0mg/L组与H-FABP<8.0mg/L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异(P<0.01);cTnI≥1.0mg/L组与cTnI<1.0mg/L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异(P<0.01);血清H-FABP、cTnI与患者冠状动脉病变严重程度的二元线性回归方程:Y=15.664 2.833x1 1.034x2(Y为Gensini积分,x1血中H-FABP浓度,x2为cTnI浓度);标准回归系数r为0.518和0.253(P<0.01)。结论H-FABP、cTnI与近期发作ACS的患者冠状动脉病变严重程度呈正相关,H-FABP与冠脉病变程度相关程度更高。血清H-FABP、cTnI升高是冠状动脉病变急性加重的直接结果,临床可根据血清H-FABP升高推断冠脉病变的危险度并采取积极的治疗措施。     

心型脂肪酸结合蛋白、肌钙蛋白Ⅰ与急性冠脉综合征冠状动脉病变程度的相关分析

目的探讨心型脂肪酸结合蛋白（H-FABP）、肌钙蛋白Ⅰ（cTnⅠ）与近期发作急性冠脉综合征（ACS）的患者冠状动脉病变严重程度的相关性及原因分析。方法ACS患者于发作12h内入院，1周内行冠脉造影者98例入选，其中急性心肌梗死（AMI）21例、不稳定型心绞痛（UAP）77例。采用双抗体夹心ELISA法定量测量待测血清H-FABP、cTnⅠ；根据关国心脏病协会所规定的冠状动脉血管图像记分分段评价标准，对病变狭窄程度进行分度、累及血管支数计算，采用Gensini积分系统，对冠脉血管病变狭窄程度、病变部位、范围进行定量评定；用卡方检验分析血H-FABP、cTnⅠ与狭窄程度、病变支数的相关性；采用二元回归分析方法分析血清H-FABP、cTnⅠ与患者冠状动脉病变严重程度的相关性。结果H-FABP≥8、0mg／L组与H-FABP〈8．0mg／L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异（P〈0．01）；cTnⅠ≥1、0mg／L组与cTnⅠ〈1．0mg／L组冠状动脉狭窄程度、累及支数及Gensini积分有明显差异（P〈0．01）；血清H-FABP、cTnⅠ与患者冠状动脉病变严重程度的二元线性回归方程：Y=15．664＋2．833x1＋1．034 x2（Y为Gensini积分，x1血中H-FABP浓度，x2为cTnⅠ浓度）；标准回归系数r为0．518和0．253（P〈0．01）。结论H-FABP、cTnⅠ与近期发作ACS的患者冠状动脉病变严重程度呈正相关，H-FABP与冠脉病变程度相关程度更高。血清H-FABP、cTnⅠ升高是冠状动脉病变急性加重的直接结果，临床可根据血清H-FABP升高推断冠脉病变的危险度并采取积极的治疗措施。     

心脏型脂肪酸结合蛋白在不稳定型心绞痛患者危险分层诊断中的价值

目的探讨不稳定型心绞痛（UAP）患者不同危险分层血清心脏型脂肪酸结合蛋白（H-FABP）的水平及临床意义。方法分别测定稳定型心绞痛（SAP）患者20例（SAP组）、UAP患者55例（UAP组）、健康体检者30例（对照组）的血清H-FABP水平,并根据危险分层将UAP组分为低危组、中危组、高危组三个亚组。结果对照组血清H-FABP水平为（4．24±1．40）ng／ml,SAP组为（4．46±1．30）ng／ml,UAP组为（6．05±1．57）ng／ml;UAP低危组、中危组、高危组分别为（4．82±1．18）、（5．96±1．01）、（7．51±1．11）ng／ml。UAP低危组、SAP组、对照组血清H-FABP水平两两比较均无统计学差异（P均〉0．05）;UAP组与对照组、SAP组比较均有统计学差异（P均〈0．01）;UAP低危组、中危组、高危组两两比较均有统计学差异（P均〈0．01）。结论血清H-FABP水平随UAP危险程度增加而升高,可根据H-FABP水平对UAP患者进行危险分层。     

Circulating levels of heart-type fatty acid-binding protein and its relation to thallium-201 perfusion defects in patients with hypertrophic cardiomyopathy

Myocyte loss and replacement fibrosis have been observed in patients with hypertrophic cardiomyopathy (HC) with heart failure. This study was designed to elucidate whether heart-type fatty acid-binding protein (H-FABP), a sensitive biochemical marker for myocardial damage, indicates ongoing myocardial damage in patients with HC. We studied 48 patients with HC and 17 control subjects. Patients with HC were divided into 2 groups according to the New York Heart Association (NYHA) functional class: NYHA I + II (n = 40) and NYHA III + IV (n = 8). Serum H-FABP and myoglobin levels were measured, and extent score was used to assess the extent of thallium-201 perfusion defect. Serum H-FABP levels were significantly higher in patients with HC than in control subjects (3.8 +/- 1.6 vs 2.6 +/- 0.7 ng/ml, p = 0.0032). Furthermore, serum H-FABP levels were significantly higher in NYHA III + IV than in NYHA I + II (5.2 +/- 1.3 vs 3.5 +/- 1.5 ng/ml, p = 0.0043). Serum myoglobin levels showed no significant difference among the 3 groups (control, 46.6 +/- 15.0 ng/ml; NYHA I + II, 55.5 +/- 26.4 ng/ml; NYHA III + IV, 65.1 +/- 33.6 ng/ml, p = 0.2115). Extent score correlated positively with serum H-FABP levels (r = 0.420, p = 0.0026) and negatively with fractional shortening (r = -0.542, p <0.0001). Increased H-FABP levels indicate ongoing myocardial damage, which could result in clinical deterioration in patients with HC.     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

代谢综合征(MS)组(n=121)的血清脂肪细胞型脂肪酸结合蛋白(A-FABP)水平较对照组(n=120)显著升高[(14.7±4.8 vs 6.8±3.0)μg/L,P<0.001].腹型肥胖MS患者的血清A-FABP水平较非腹型肥胖MS患者显著升高[(15.7±4.2 vs 12.6±5.1)μg/L,P<0.001].血清A-FABP水平与体重指数、腰围、腰臀比、空腹胰岛素、稳态模型评估的胰岛素抵抗指数、空腹血糖、甘油三酯、总胆同醇及平均动脉压等指标均呈正相关(r分别为0.603、0.534、0.411、0.424、0.401、0.370、0.460、0.208和0.522,均P<0.05),而与HDL-C旱显著负相关(r=-0.448,P<0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

脂肪细胞型脂肪酸结合蛋白与代谢综合征相关

Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).     

非酒精性脂肪性肝病与脂肪细胞型脂肪酸结合蛋白的相关性

目的 通过测定患者血清脂肪细胞型脂肪酸结合蛋白（AFABP）水平,探讨血清AFABP与非酒精性脂肪性肝病（NAFLD）的相关性.方法 选取2010年7月至2010年11月于宁夏医科大学附属医院体检的人员160例.根据中华医学会非酒精性脂肪性肝病诊断标准将观察对象分为对照组（71例）和NAFLD组（89例）,分别比较两组间一般情况、身体质量指数（BMI）、血压、AFABP、血清胰岛素及血清学指标等各项病例资料.Spearman相关用于进一步分析血清AFABP与NAFLD及各代谢指标的相关性.计量资料组间比较采用t检验和秩和检验,计数资料组间比较采用χ2检验.结果 NAFLD组患者以男性为多,且与对照组比较,其存在更高的BMI、血糖、甘油三酯（TG）、ALT、AST及尿酸水平亦较高,而HDL水平较低;NAFLD组患者血清AFABP、胰岛素及胰岛素抵抗指数水平均高于对照组,差异有统计学意义;将AFABP与各参数进行Spearman相关分析研究显示,血清AFABP与NAFLD、BMI、胰岛素抵抗指数、血清胰岛素、血糖、TG、ALT、AST及尿酸水平呈正相关,而与HDL水平呈负相关;校正性别、年龄及BMI后,血清AFABP与NAFLD、胰岛素抵抗指数、血清胰岛素、血糖、TG、ALT及尿酸水平呈正相关,与HDL及AST水平无明显相关.结论 血清AFABP水平与NAFLD关系密切,其可能是NAFLD的独立血浆标志物,在NAFLD的发生发展中起了重要的作用.     

Prognostic value of a qualitative test for heart-type fatty acid-binding protein in patients with acute coronary syndrome

Heart-type fatty acid-binding protein (h-FABP) is a novel diagnostic marker for myocardial infarction, but its prognostic value has not been established in patients with acute coronary syndrome (ACS). We sought to determine the value of qualitative analysis of h-FABP for predicting 30-day adverse events in patients with ACS. A retrospective observational study was conducted on patients at a community hospital, and 130 patients admitted through the emergency room (ER) for ACS were identified among 12,077 patients who presented to the ER between January and June 2003. Of these 130 patients, 90 (mean age, 66.8 years, 67 males) who had ACS were eligible for this study. Qualitative tests for serum h-FABP and troponin T (cTnT) were performed on presentation. Follow-up information on adverse events within 30 days after admission, defined as cardiac death or recurrent ACS, was obtained from the medical records. The qualitative tests for h-FABP and troponin T were positive in 62.2% and 36.7%, respectively. The cumulative adverse event rate at 30 days was 14.8% in the h-FABP-positive group and 3.2% in the negative group. The adjusted relative risk of a positive h-FABP test for adverse events was 44.98 (95% CI: 1.48 to 1,364.88). A positive h-FABP test was an independent predictor of adverse events within 30 days in these patients.