心型脂肪酸结合蛋白对急性冠脉综合征患者的诊断价值及预后评估的研究

目的探讨心型脂肪酸结合蛋白（H-FABP）对急性冠脉综合征（ACS）患者诊断及预后评估的价值。方法选择急性心肌梗死（AMI）患者108例;不稳定性心绞痛（UA）患者90例;稳定性心绞痛（SA）患者84例;健康对照组60例。患者各组分别在入院时和入院8h后检测血清H-FABP、cTnI和CK-MB水平。结果入院时,AMI组和UA组H-FABP水平高于SA组和对照组（P〈0.05）,AMI组CK-MB水平高于其他三组（P〈0.05）,H-FABP对AMI和UA的诊断阳性率明显高于cTnI和CK-MB（P〈0.05）;入院8h后,H-FABP水平下降,cTnI和CK-MB水平上升,AMI组H-FABP水平高于其他三组（P〈0.05）,AMI组和UA组cTnI和CK-MB水平明显高于SA组和对照组（P〈0.05）,H-FABP对AMI的诊断阳性率与cTnI和CKMB相比差异无统计学意义（P〉0.05）,而对UA的诊断阳性率低于cTnI和CK-MB（P〈0.05）。发生心脏意外事件的ACS患者H-FABP水平明显高于未发生心脏意外事件的ACS患者（P〈0.01）。结论 H-FABP对ACS患者的早期诊断具有较高的准确性;当发病超过8h后,应联合其他心肌酶学指标共同诊断。临床可结合H-FABP水平对ACS患者预后进行评估。

Clinical Value of Heart-type Fatty Acid-Binding Protein in Patients with Acute Coronary Syndrome

Objective To study clinical value of heart- type fatty acid- binding protein （ H- FABP） in acute coro- nary syndrome （ACS）. Methods The present study was carried out include acute myocardial infarction group （n = 108, AMI）, unstable angina group （ n = 90, UA）, stable angina group （ n = 84, SA） and 60 people served as healthy control. The serum H-FABP, cardiac troponin I （cTnI） and creatine kinase MB fraction （CK-MB） levels were measured in all patients enrolled at admission and 8 hours after admission. Results At patients admission, the H- FABP level in AMI and UA groups were higher than that in SA and controls （ P 〈 0.05 ）, while the CK- MB level in AMI was higher than that in other three groups （ P 〈 0.05 ）. The H- FABP had significantly higher diagnostic accuracy superior to cTnI and CK- MB in AMI and UA （ P 〈 0.05 ）. At 8 hours after admission, the H-FABP level trended to decline, while cTnI and CK-MK were increased. The H- FABP level in AMI was higher than that in other three groups （P 〈 0.05 ）. The levels of cTnI and CK- MB in AMI and UA were markedly higher than those in SA and controls （ P 〈 0.05 ）. The H- FABP had no significant accuracy for AMI compared with cTnI and CK- MB （P 〉 0. 05 ） , and less accuracy for UA than other two mark- ers （P 〈 0.05 ）. The ACS with emergency had markedly higher H- FABP than that without ACS （P 〈 0. 01 ）. Conclusion H-FABP shows high accuracy for the early diagnosis in ACS patients, but other biochemical cardi- ac markers would be combined for diagnosis after 8 hours later from symptom onset. The H-FABP level could be used for prognosis evaluation of ACS.