Tambara Keiichi, Fujita Masatoshi, Miyamoto Shoichi, Doi Kazuhiko, Nishimura Kazunobu, Komeda Masashi
Department of Cardiovascular Surgery, Kyoto University, Kyoto, Japan.
Int J Cardiol. 2004 Feb;93(2-3):281-4. doi: 10.1016/S0167-5273(03)00219-5.
Heart-type cytoplasmic fatty acid-binding protein (H-FABP) has been reported as a sensitive and specific marker for the early diagnosis of acute myocardial infarction. Our hypothesis was that serum or pericardial fluid levels of H-FABP can reflect not only myocardial infarction but also myocardial ischemia.
A total of 34 patients with unstable angina, who had anginal symptoms and/or ST-changes in ECG monitoring within 24 h before operation, were classified into group A (n=17), and those without these symptoms and changes into group B (n=17). Blood and pericardial fluid samples were obtained immediately after median sternotomy, and serum and pericardial fluid levels of creatine kinase-MB, cardiac troponin-T, and H-FABP were measured.
Serum H-FABP levels were slightly elevated compared with their normal values in both groups. While they showed no difference between groups A and B (group A vs. B: 8.5+/-1.0 vs. 7.1+/-0.7 ng/ml, P=0.25), pericardial fluid levels of H-FABP were significantly higher in group A than in group B (16.3+/-2.0 vs. 9.6+/-1.0 ng/ml, P=0.0046). H-FABP showed a weak correlation between its serum levels and pericardial fluid levels (r=0.40).
Pericardial fluid levels of H-FABP reflect myocardial ischemia occurring within 24 h of their measurements. H-FABP may be secreted into the interstitial space by increased permeability of the myocardial cell membrane associated with severe myocardial ischemia. Thus, pericardial fluid reflects pathophysiological conditions of cardiomyocytes more sensitively than circulating blood.
心脏型细胞质脂肪酸结合蛋白（H-FABP）已被报道为急性心肌梗死早期诊断的敏感且特异的标志物。我们的假设是，血清或心包液中H-FABP水平不仅可以反映心肌梗死，还可以反映心肌缺血。
共有34例不稳定型心绞痛患者，在手术前24小时内心电图监测有胸痛症状和/或ST段改变，将其分为A组（n = 17），无这些症状和改变的患者分为B组（n = 17）。在正中胸骨切开术后立即采集血液和心包液样本，测量血清和心包液中肌酸激酶-MB、心肌肌钙蛋白-T和H-FABP的水平。
两组患者血清H-FABP水平均较正常水平略有升高。虽然A组和B组之间无差异（A组 vs. B组：8.5±1.0 vs. 7.1±0.7 ng/ml，P = 0.25），但A组心包液中H-FABP水平显著高于B组（16.3±2.0 vs. 9.6±I.0 ng/ml，P = 0.0046）。H-FABP血清水平与心包液水平之间呈弱相关性（r = 0.40）。
心包液中H-FABP水平反映了在测量前24小时内发生的心肌缺血。H-FABP可能通过与严重心肌缺血相关的心肌细胞膜通透性增加而分泌到间质空间。因此，心包液比循环血液更敏感地反映心肌细胞的病理生理状态。
