H-FABP对非体外循环冠状动脉旁路移植术后心肌损伤的早期诊断价值  

Clinical role of heart-type fatty acid-binding protein in the early diagnosis of myocardial injury resulting from off-pump coronary artery bypass grafting

作　　者：杨懋颖[1] 吴昌昊[2] 黄晓燕[2] 金自瑛[3] 

机构地区：[1]浙江大学医学院附属第二医院滨江院区胸外科,浙江杭州310052 [2]浙江医院心脏外科,浙江杭州310013 [3]浙江大学医学院附属儿童医院麻醉科,浙江杭州310052

出　　处：《健康研究》2016年第5期520-523,共4页Health Research

基　　金：浙江省医药卫生一般研究计划(2012KYA004)

摘　　要：目的探讨H-FABP对非体外循环冠状动脉旁路移植术(OPCABG)后心肌损伤的早期诊断价值。方法收集40例首次行OPCABG冠心病患者,按照心电图、血心脏标记物及UCG的变化将患者分成心肌损伤组(6例)和对照组(34例),分别在术前1天、术中末端血管吻合毕时0 h、2 h、4 h、24 h、48 h、72 h采中心静脉血检测H-FABP、CK-MB、c Tnl水平。结果术前两组患者间静脉血中的H-FABP、c Tn I和CK-MB水平均无显著性差异(P>0.05);在心肌损伤组,手术后各时间点血清H-FABP水平较术前显著升高((F=7.900,P=0.007),并在术后2 h即达到峰值;术后各时间点的c Tn I水平较术前显著升高(F=3.789,P=0.045),并于术后4h才达到峰值,且峰可持续24h;血清CK-MB值于术后4 h明显升高(F=3.533,P=0.015),且于术后24 h到达峰值。结论对OPCABG术后心肌损害的检测,H-FABP较CK-MB、c Tn I更具优势,其能更早期发现心肌损害,并能预示心肌损害的程度。Objective To understand the clinical role of heart-type fatty acid-binding protein（ H-FABP） in the early diagnosis of myocardial injury resulting from off-pump coronary artery bypass grafting（ OPCABG）. Method 40 patients having undergone OPCABG were divided into a control group（ n = 34） and an experimental group（ those with myocardial injury,n = 6） according to the clinic characteristic information. The serum cardiac tropoin I（ c Tn I）, creatine phosphokinase isoenzyme（ CK-MB） and heart-type fatty acid-binding protein（ H-FABP） levels were measured the day beforeoperation. These indices were measured at the six point after operation： 10 hour after coronary anastomosis; 22 hours; 34 hours; 424 hours; 548 hours; and672 hours after coronary anastomosis. Findings No significant difference was found in c Tn I,CK-MB and H-FABP levels between the control group and the experimental group before operation. In the experimental group,the serum levels of H—FABP significantly increased after OPCABG（ P〈0. 01）. Serum H-FABP level increased and reached at peak level within 2 hours. In the experimental group,the serum levels of c Tn I significantly increased and reached at their peak level within 4 hours after coronary anastomosis（ P〈0. 05）. In the experimental group,the serum levels of CK-MB significantly increased within 4 hours after coronary anastomosis（ P〈0. 05）. The time for the peak serum level of CK-MBl was 24 hours,respectively. The serum H—FABP levels increased earlier than that of CK-MB and c Tn I. Conclusion Experiment results showed that the detection of the heart-type fatty acid-binding protein is superior to commonly used detection of the CK-MB and c Tn I. The serum H—r FABP levels could have great values in the diagnosis of myocardial injury as well as its degree in patients undergoing OPCABG.

关 键 词：心脏脂肪酸结合蛋白 非体外循环冠状动脉旁路移植术 心肌损伤 

分 类 号：R654[医药卫生—外科学]