Ishii Junnichi, Ozaki Yukio, Lu Jingchao, Kitagawa Fumihiko, Kuno Takahiro, Nakano Tadashi, Nakamura Yuu, Naruse Hiroyuki, Mori Yoshihisa, Matsui Shigeru, Oshima Hisaji, Nomura Masanori, Ezaki Kouji, Hishida Hitoshi
Division of Critical Care, Fujita Health University Graduate School of Health Sciences, Toyoake, Japan.
Clin Chem. 2005 Aug;51(8):1397-404. doi: 10.1373/clinchem.2004.047662. Epub 2005 Jun 10.
Heart-type fatty acid-binding protein (H-FABP) is proposed as an early biomarker for acute myocardial infarction (AMI), but its prognostic value is unclear in acute coronary syndrome (ACS). We evaluated the prognostic value of the H-FABP concentration relative to cardiac troponin T (cTnT) in the early hours of ACS.
Serum concentrations of H-FABP and cTnT were measured on admission in 328 consecutive patients hospitalized for ACS within 6 h after the onset of chest pain [AMI, 241 (73.5%) patients; ST-segment elevation myocardial infarction, 154 (47.0%) patients; and emergent coronary angiography within 24 h after admission, 287 (87.5%) patients]. Cardiac events, which were defined as cardiac death or subsequent nonfatal AMI, were monitored for 6 months after admission.
During the 6-month follow-up period, there were 25 cardiac events, including 15 cardiac deaths and 10 subsequent nonfatal AMIs. Stepwise multivariate analyses including clinical, electrocardiographic, and biochemical variables revealed that increased H-FABP (above the median of 9.8 microg/L), but not increased cTnT (above the median of 0.02 microg/L), was independently associated with cardiac events in all patients [relative risk (RR) = 8.96; P = 0.0004], the subgroup of patients with ST-segment elevation myocardial infarction (RR = 11.3; P = 0.02), and the subgroup of patients with unstable angina and non-ST-segment elevation myocardial infarction (RR = 8.31; P = 0.007). The area under the ROC curve was higher for H-FABP than for cTnT (0.711 vs 0.578; P = 0.08), suggesting that H-FABP concentrations have a greater predictive capacity for cardiac events than cTnT.
Serum H-FABP is a potential independent predictor of cardiac events within 6 months of patient admission and may provide prognostic information superior to cTnT in the early hours of ACS.
心脏型脂肪酸结合蛋白（H-FABP）被认为是急性心肌梗死（AMI）的早期生物标志物，但在急性冠状动脉综合征（ACS）中其预后价值尚不清楚。我们评估了ACS早期H-FABP浓度相对于心肌肌钙蛋白T（cTnT）的预后价值。
对328例因胸痛发作6小时内住院的ACS连续患者入院时测定血清H-FABP和cTnT浓度[AMI，241例（73.5%）；ST段抬高型心肌梗死，154例（47.0%）；入院后24小时内行急诊冠状动脉造影，287例（87.5%）]。对入院后6个月的心脏事件进行监测，心脏事件定义为心源性死亡或随后的非致命性AMI。
在6个月的随访期内，发生25例心脏事件，包括15例心源性死亡和10例随后的非致命性AMI。包括临床、心电图和生化变量的逐步多变量分析显示，H-FABP升高（高于中位数9.8μg/L），而非cTnT升高（高于中位数0.02μg/L），在所有患者[相对危险度（RR）=8.96；P=0.0004]、ST段抬高型心肌梗死亚组（RR=11.3；P=0.02）以及不稳定型心绞痛和非ST段抬高型心肌梗死亚组（RR=8.31；P=0.007）中均与心脏事件独立相关。H-FABP的ROC曲线下面积高于cTnT（0.711对0.578；P=0.08），表明H-FABP浓度对心脏事件的预测能力大于cTnT。
血清H-FABP是患者入院后6个月内心脏事件的潜在独立预测指标，在ACS早期可能提供优于cTnT的预后信息。
Zotero 插件