急性心肌梗死患者血浆心型脂肪酸结合蛋白的动态变化及意义

目的 探讨急性心肌梗死（AMI）患者心型脂肪酸结合蛋白（H-FABP）的动态变化和临床意义.方法 采用固相夹心酶联免疫法（ELISA）测定50例AMI患者发病后6 h以内（PCI术前）,发病后9 h、12 h、24 h、48 h血浆H-FABP、肌红蛋白（MYO）、肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）浓度.将AMI患者分为死亡组、并发症组和无并发症组进行对比分析.结果 AMI患者血浆H-FABP浓度为（35.13±5.72）μg/L,明显高于对照组的（5.16±1.43）μg/L,差异有统计学意义（P＜0.01）.3个亚组中无并发症组患者血浆H-FABP浓度在发病后4～6 h达高峰,12～24 h恢复到正常范围;而并发症组和死亡组患者血浆H-FABP浓度在各个时间点都高于无并发症组,而且峰值延迟、持续不降并有增高趋势.三组的组间、不同时间点,以及组间和不同时间点的交互作用差异均有统计学意义（P＜0.05）.结论 H-FABP是AMI早期诊断的特异性生化标记物,对AMI有重要的诊断价值.AMI患者血浆H-FABP峰值延长甚至持续升高可能与心肌梗死后各种并发症对心肌细胞的持续损伤有关,H-FABP浓度的动态变化对AMI患者危险分层有一定的预测价值.

Dynamic changes and significance of H-FABP in patients with acute myocardial infarction

Objective To investigate the dynamic changes and clinical significance of H-FABP in patients with AML Methods This study adopts ELISA to assay H-FABP,MYO, cTnI, CK-MB concentrations in plasma at 0-6, 9, 12, 24, and 48 hours after presentation in 50 patients with AMI. The AMI group was divided into three subgroups： the death subgroup, the complication subgroup and the non-complication subgroup and they were relatively analyzed. Results H-FABP concentrations in plasma of patients with AMI was higher than that of the controls （ 35.13±5.72 ） μg/L vs （ 5.16± 1.43 ） μg/L ], and the difference between them has statistical significance（P〈0.01 ）. Among the three subgroups, peak levels of H-FABP in plasma in the non-complication subgroup appeared 4-6 h after presentation, then returned to normal range at 12-24 h after presentation. H-FABP levels in both the complication subgroup and the death subgroup were obviously higher than that in the non-complication subgroup at each time point. Their peaks were delayed, remained high and had an increase trend. Among three subgroups, the different time points, and the interaction of among groups and the different time points, the three differences were statistically significant （P〈0.05）. Conclusion H-FABP is a specific biochemical marker in the early diagnosis of acute myocardial infarction and it is fairly important for the diagnosis of AMI. The peak extension and even continuous rise of its peak are probably related to the damage of myocardial cell of which many complication cause after AMI. The dynamic change of H-FABP concentration has determinate predictive values in the risk stratification of AMI patients.