心型脂肪酸结合蛋白在心梗患者行介入治疗中的意义

摘要

目的 观察ST段拾高型心肌梗死患者行经皮冠脉介入治疗(PCI)前后心型脂肪酸结合蛋白(H-FABP)变化及意义.方法 选择北京朝阳医院急诊科确诊ST段抬高型心肌梗死患者178例,根据PCI术后ST段回落程度分为两组,即ST段回落组及ST段无回落组,分别为137人及41人.所有病例均于入院即刻测定H-FABP及心肌肌钙蛋白(cTnI),并在PCI术后1h,6h,12 h和24 h再分别测定H-FABP质量浓度,PCI术后12h及24 h测定cTnI.测定PCI术后2 hST段回落幅度(ΣSTR).结果 ST段回落组及ST段无回落组PCI术前人口统计学资料差异无统计学意义.两组患者术后6 h H-FABP明显高于术前(P＜0.05),ST段回落组患者于24 h H-FABP恢复至正常水平,而ST段无回落组患者H-FABP未降至正常水平.结论 ST段抬高型心肌梗死患者血清H-FABP升高与冠脉病变程度有关,PCI术可影响H-FABP变化,ΣSTR≥50％与H-FABP降至正常水平以下有利于判断患者的心肌损伤程度和心肌再灌注.%Objective To observe the change and clinical significance of the heart type fatty acid binding protein (H-FABP) in ST Segment Elevation Myocardial Infarction (STEMI) after percutaneous coronary intervention (PCI).Methods Of 178 STEMI patients were recruited and were separated as ST segment drop group (137) and ST segment non-drop group (41).All the patients received H-FABP and cTnI tests,and re-tested H-FABP on 1 h,6 h,12 h and 24 h after the PCI,and re-tested cTnI on 12 h and 24 h after the PCI.Also,the ST segment drop amplitude (ΣSTR) was measured 2 h after the PCI.Results The demographics of both groups were similar.In both groups,the H-FABP on 6 h after PCI was significantly higher than the value measured prior to PCI.In the ST segment drop group,the H-FABP was reduced to normal value on 24 h after PCI,while it was not in the ST segment non-drop group.Conclusions The H-FABP elevation is associated with the severity of coronary lesions in ST segment elevation myocardial infarction,and the PCI may be involved in the H-FABP changes.ΣSTR≥50％ and normal HFABP may be used as index for judgment of myocardial injury and myocardial reperfusion.