心肌型脂肪酸结合蛋白对血流动力学稳定的急性肺栓塞患者近期预后的预测价值

目的评价心肌型脂肪酸结合蛋白(H-FABP)对血流动力学稳定的急性肺栓塞(APE)患者近期预后的预测价值。方法选取2009年8月—2011年12月我院住院的APE患者共102例,均经过多层螺旋CT肺动脉造影确诊。根据血H-FABP测定值分为两组:阳性组:H-FABP≥10μg/L(n=26),阴性组:H-FABP<10μg/L(n=76)。比较两组患者的症状、体征、血气分析、超声心动图检查结果,比较两组晕厥、死亡等不良事件发生率的差异。结果两组患者出现呼吸困难、体检发现存在紫绀、颈静脉充盈、存在P2亢进、肝大有压痛的发生率间差异有统计学意义(P<0.05)。两组患者的动脉血氧分压、动脉血二氧化碳分压、肺泡-动脉氧压力差比较,差异均有统计学意义(P<0.05);两组患者右室功能指标:肺动脉压力、右心室内径、肺动脉内径比较,差异均有统计学意义(P<0.05)。H-FABP阳性组出现呼吸衰竭13例、休克5例,行机械通气者7例,30 d内死亡6例;H-FABP阴性组患者无一例出现休克、呼吸衰竭、机械通气,无死亡病例。结论 H-FABP水平对于判断APE患者右室功能有一定的临床价值,其水平升高提示预后不良,有助于对APE患者进行危险分层。

Value of Heart Fatty Acid Binding Protein in Predicting the Recent Prognosis of Acute Pulmonary Embolism Patients with Stable Hemodynamics

Objective To evaluate the predictive value of heart-type fatty acid-binding protein(H-FABP) for the recent prognosis of acute pulmonary embolism patients with stable hemodynamics.Methods Totally 102 patients with MDCT pulmonary artery imaging-confirmed acute pulmonary embolism were enrolled in this study.Patients were divided into two groups according to the serum H-FABP levels:positive groups(H-FABP ≥10 μg/L,n=26) and negative groups(H-FABP<10 μg/L,n=76).The symptoms,signs,blood gas profiles,and echocardiography results were recorded and compared between these two groups.Furthermore,the major adverse events such as mechanical ventilation and death were also compared.Results The incidences of dyspnea,cyanosis,engorgement of the neck veins,and P2 hyperthyroidism were significantly different between H-FABP positive group and negative group(P<0.05).Significant differences were found in terms of PaO2,PaCO2,and P(A-a)O2(P<0.05).Indicators for the right ventricular function including the diameter of right ventricle,pulmonary artery pressure,and right ventricular wall motion also showed significant differences(P<0.05).The incidences of syncope,shock,right heart dysfunction,fibrinolytic therapy,and mechanical ventilation in the positive group were much higher than those in negative group.Conclusion Plasma H-FABP level can distinguish RV dysfunction to some degree in acute pulmonary embolism patients.Increased H-FABP level predicts poor prognosis and therefore is useful for risk stratification in patients with acute pulmonary embolism.