心脏型脂肪酸结合蛋白对急性肺栓塞早期危险分层和预后预测的价值

摘要

[目的]:探讨急性肺栓塞(APE)患者起病24h内,心脏型脂肪酸结合蛋白(H-FABP)对危险分层和预后预测的价值.[方法]:选择2009年6月至2010年10月至急诊就诊的发病24h内的APE患者,按危险分层分为高危组、中危组和低危组,记录各组基线资料,以及超声心动图右心室腔径、估测肺动脉收缩压、心率、动脉血氧分压等结果,对各组H-FABP和肌钙蛋白I(cTNI)阳性率进行统计分析,并分析各因素与住院期间不良事件(死亡、气管插管和心肺复苏)发生率之间的相关性.结果:共有55例符合条件的APE患者入选,女性患者共30例；高危组12例,中危组25例,低危组18例；3组入院时心率、动脉血氧分压、肺动脉收缩压、溶栓二聚体(D-Dimer)在各组间差异有显著统计学意义.高危组患者入院时间显著早于中危组和低危组(中位数分别为4h vs.8h vs.14h,P=0.001),右心室腔径更大[(32.3±9.1)mm vs.(29.1±7.8)mm vs.(22.6±8.4)mm,P=0.017),肺动脉收缩压更高(中位数分别为40 mmHg vs.20 mmHg vs.15 mmHg,P=0.033,1 mmHg=0.133 kPa),住院期间不良事件发生率也显著高于中低危组.H-FABP阳性率显著高于cTNI阳性率(78.2％ vs.43.6％,P=0.017).相关性分析显示,H-FABP阳性率与不良事件发生率显著相关(r=0.875,P =0.037),而cTNI与不良事件发生率的相关性未达统计学意义(r =0.115,P=0.059).结论:APE发病后早期H-FABP敏感性显著高于cTNI,且与住院期间不良事件发生率显著相关.%Objective: To explore the value of heart fatty acid binding protein ( H-FABP) in the stratification and prognosis of acute pulmonary embolism (APE) patients. Methods:According to risk stratification, 55 APE patients admitted into emergency department within 24 hours after the onset were divided into three groups: high risk group, moderate risk group and low risk group. H-FABP and cardiac troponin I (cTNI) positive rates of all groups were analyzed and compared, and the correlation between major adverse events(death, endotracheal intubation and cardiopulmonary resuscitation) and the cardiac markers(heart rate, arterial partial pressure of oxygen, right ventricular dimension, pulmonary arterial pressure, etc) during the in-hospital period were statistically analyzed. Results:The admission time of high-risk group patients was earlier than non-high risk group [4 h vs. 8 h vs. 14 h, P =0.001) ], had larger right ventricular dimension [ (32. 3 ±9. l)mm vs. (29. 1 ±7. 8)mm vs. (22.6±8.4)mm, P=0.0l7] and pulmonary arterial pressure (40 mmHg vs. 20 mm Hg vs. 15 mmHg, P = 0.033). The major adverse events during in-hospital period, including death, endotra-cheal intubation, and cardiopulmonary resuscitation, were significantly higher in high-risk group than those in non high-risk group. The further analysis indicated that the positive rate of H-FABP was remarkably higher than cTNI (78.2% vs. 43.6%,P=0.017). The H-FABP (r=O.875,P =0.037) was significantly correlated to the major adverse events, however, so as not cTNI (r = 0.115, P = 0.059). Conclusion: The positive rate of H-FABP is significantly higher than cTNI during 24 h after the onset of APE. The H-FABP was significantly correlated to the major adverse events.