心肌脂肪酸结合蛋白变化与OPCAB后心肌梗死

摘要

Objective To evaluate the relationship between the change of Heart-fatty acid-binding protein and myocardial injury/infarction in postoperative of off-pump coronary artery bypass grafting (OPCAB).Methods 59 patients (male 37 and female 22,from 46 to 83 years old) who were the first time to undergoing OPCAB were included in this study.Serial venous blood samples were taken at after induction of anesthesia,the OPCAB finished (after the last anastomosis),entered ICU,2,4 and 8 hours after the patient entered ICU,and at 1 and 2 day postoperative to test H-FABP.The cTnI and CK-MB were tested at 4 and 8 hours,after entering ICU,and at 1 and 2 days postoperative.Patients were divided into 3 groups by the changes of ECG and the level of cTnl at 8 hours after they entered ICU:normal group (group I,cTnI ＜0.1 ng/ml),myocardial injury group(group Ⅱ,cTnI 0.l-1.0 ng/ml) and.myocardial infarction group(group Ⅲ,cTnI ＞ 1.0 ng/ml).Results The level of H-FABP released was significantly higher in the myocardial infarction group than normal group and myocardial injury group (P ＜ 0.01).There is good correlation between the H-FABP and cTnI or CK-MB.But the peak level of H-FABP is earlier (finished OPCAB) (P ＜ 0.05),and it peaked early at 2h after entered ICU (P ＜ 0.01),it began to decrease at 4 hours after entered ICU and returned to baseline at 1 day postoperative,while the cTnI and CK-MB peaked at postoperative day 1 and 8h after entered ICU respectively,and maintained in higher level at postoperative 2 days.Conclusion There is good correlation between the H-FABP and perioperative myocardial infarction in OPCAB,and it has superiority compared with cTnI,which is as "gold standard" for perioperative myocardial infarction,on a certain degree.It can benefit from early detection of H-FABP for myocardial infarction in perioperative of OPCAB.%目的 探讨心肌型脂肪酸结合蛋白(H-FABP)与非体循环外冠状动脉旁路移植术(OPCAB)后心肌损伤及心肌梗死的关系.方法 59例首次单纯行OPCAB的患者,分别于麻醉诱导后、CABG手术结束(最后1支旁路血管吻合完毕)、入ICU即刻、2、4、8h及术后l天抽取中心静脉血检测H-FABP含量；于术前、入ICU 4、8h、术后1、2天分别常规化验cTnI、CK-MB.根据术后8h的cTnI值及心电图的改变将患者分为正常组(I组,cTnI＜0.1 ng/ml)、心肌损伤组(Ⅱ组,cTnI 0.1～ 1.0 ng/ml)、心肌梗死组(Ⅲ组,cTnI＞1 ng/ml).结果 心肌梗死组的H-FABP显著高于心肌损伤组及正常组(P＜0.01),H-FABP与cTnI、CK-MB有良好的相关性.H-FABP在入ICU 2 h达峰值,显著早于cTnI、CK-MB(P＜0.01),且入ICU 4 h即开始下降,术后1天回到基线水平.而cTnI、CK-MB达峰值的时间分别是术后8h和1天,且术后2天仍维持在较高水平.结论 H-FABP与OPCAB围手术期心肌梗死有良好的相关性,且与“金标准”cTnI比较具有一定的优越性,早期监测H-FABP对诊断围手术期心肌梗死具有较为突出的应用价值.