血清游离脂肪酸水平与冠心病心肌损伤程度相关性研究

目的探讨血清游离脂肪酸（free fatty acid，FFA）作为一种非酯化的脂肪酸对心肌是否存在损伤作用，以及总胆固醇（total cholesterol，TCHO）、甘油三酯（triglyceride，TG）、高密度胆固醇（high densisty lipoprotein，HDL）、低密度胆固醇（low densisty lipoprotein，LDL）对心肌损伤的影响。方法抽取189例冠心病患者血样，根据心肌肌钙蛋白T检测结果，将研究对象分为心肌损伤组（心肌肌钙蛋白T〉0．08ng／L）88例与非心肌损伤组（心肌肌钙蛋白T正常）101例，抽取正常人群93例为对照组，利用酶终点法测FFA，酶法测TCHO，GPO—PAP法测TG，免疫比浊法测HDL和LDL。结果冠心病心肌损伤组冠心病心肌损伤组FFA水平显著高于非心肌损伤组和对照组（P〈0．05），而血样中其他指标如TCHO、TG、HDL、LDL差异无统计学意义（P〉0．05）。ROC曲线发现FFA曲线下面积为0．89。以0．65作为Cutoff值时，FFA诊断灵敏度可达71％，特异度达90％。冠心病患者的血脂正常组较血脂异常组的心肌损伤发生率显著降低（P〈0．05），进一步统计分析显示FFA、TCHO、TG、LDL、HDL无相关性。结论血清FFA水平与心肌损伤明显相关，可作为冠心痛患者心肌损伤的预测指标，而TCHO、TG、HDL、LDL与心肌损伤关系较小。FFA可成为监测心肌损伤独立的危险因素。

Study of correlation between serum free fatty acids and myocardial injury

Objective To identify whether serum free fatty acids （FFA）, as nonesterified fatty acids, would injury myocardium; and to evaluate effects of total cholesterol （TCHO）, triglyceride （TG）, high-density lipoprotein cholesterol （HDL） as well as low-density lipoprotein cholesterol （LDL） to myocardial injury. Methods Sera were collected from 93 healthy individuals and 189 patients with coronary heart disease （CHD） which were classified into two groups according to cardiac troponin T level. One group had 88 patients with myocardial injury（cardiac troponin T 〉 0.08ng/L）, the other group had 101 patients constructing the non-cardiac injury （cardiac troponin T level was normal）. FFA was detected by enzymatic end point method, TCHO was detected by enzymatic method, TG was detected by GPO-PAP, and HDL or LDL was measured by Immunoturbidimetric assay. Results FFA was significantly increased in sera from myocardial injury group as compared with non-cardiac injury group or control group （P 〈 0.05 ）. But other indexes had no significant difference among three groups （ P 〈 0.05 ）. ROC curve indicated that FFA area under the curve was 0.89. When cutoff was set at 0.65, using FFA reflecting diagnosis of myocardial injury was increased to 71%, while the specificity reached 90%. CHD patients with normal serum fatty acid had significant lower risk for myocardial injury as compared with CHD patients with high serum fatty acid（P 〈0.05）. However there were no correlations between FFA and TCHO, TG, HDL or LDL. Conclusion A good correlation between serum FFA and myocardial injury was observed. Monitoring FFA may be used as an indicator for forecasting myocardial injury since TCHO, TG, HDL and LDL were less correlated with myocardial injury. FFA may provide an independent risk factor for myocardial injury.