心型脂肪酸结合蛋白与急性冠脉综合征冠脉病变程度的相关分析

目的:探讨心型脂肪酸结合蛋白(heart-type fatty acid-binding protein,H-FABP)与近期发作急性冠脉综合征(ACS)的患者冠脉病变严重程度的相关性及原因。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21例、不稳定性心绞痛77例。采用双抗体两步夹心ELISA法定量测量待测血清H-FABP;根据美国心脏病协会所规定的冠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H检验分析H-FABP是否大于8.0ng/mL与Gensini积分的相关性,卡方检验分析血H-FABP与狭窄程度、病变支数的相关性,采用一元回归分析方法分析血清H-FABP与患者冠脉病变严重程度的相关程度。结果:H-FABP>8.0ng/mL组与H-FABP<8.0ng/mL组冠脉狭窄程度、累及支数及Gensini积分有明显差异(P<0.001);血清H-FABP与患者冠脉病变严重程度的一元回归分析结果,标准回归系数为0.658,P<0.001;一元线性回归方程,y=13.177 3.597x(y为Gensini积分,x为血中H-FABP浓度)。结论:H-FABP与近期发作ACS的患者冠脉病变严重程度呈正相关。血清H-FABP升高是冠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。

Relation between heart-type fatty acid-binding protein levels and the severity of the affected coronary artery in acute coronary syndrome

Objective To explore the relationship between heart-type fatty acid-binding protein(H-FABP) levels and the severity of the affected coronary artery in acute coronary syndrome (ACS) and to analyze the relevant reasons. Methods 98 patients with ACS (21 with acute myocardial infarction, 77 with unstable angina) who were hospitalized within 12 hours after the onset of attack and who received coronary angiogram within 7 days were enrolled in this study. Serum H-FABP levels were detected by sandwich ELISA in all patients on admission. The stricture level and affected area and extension in the coronary artery were assessed quantitively based on the Gensini's scoring system. The correlation between H-FABP greater than or less than 8.0 ng/mL and the Gensini's score was analyzed by H test and the relation between H-FABP and stricture level or the number of affected branches was measured by Chi-square test. The association between serum H-FABP and the severity of the affected coronary artery was determined by simple linear regression. Results There were significant differences in the severity of the affected coronary artery, Gensini's score, and the number of affected branches between H-FABP > 8.0 ng/mL group and H-FABP < 8.0 ng/mL group (P < 0.001). Simple linear regression equation was "y=13.177 3.597x", with "y" known as Gensini's score and "x" as H-FABP level. Standard coefficient was 0.658, P < 0.001. Conclusions H-FABP is positively related with the severity of the affected coronary artery. The elevated serum H-FABP level results directly from the acute worsening of the coronary artery. Risks of coronary artery disease can be clinically estimated by a rise in serum H-FABP level and an aggressive treatment should be performed.