Bertinchant J P, Polge A
Service de cardiologie, CHU Nîmes, place du Professeur Robert Debré, 30029 Nîmes 09.
Arch Mal Coeur Vaiss. 2005 Dec;98(12):1225-31.
Heart-type fatty acid-binding protein (H-FABP) is a 132 amino acids soluble protein, with general characteristics resembling myoglobin. Because of its low molecular weight (15 kd) and cytoplasmic location, it constitutes a biologic marker readily released into the circulation after myocardial injury. Despite the development of various immunoassays to measure H-FABP, few are currently easy to perform, quantitative and applicable in emergency. Most studies have shown the diagnostic sensitivity of H-FABP (i.e. its ability to detect the presence of a myocardial infarction) to be high, above that of myoglobin in patients presenting within 3 to 6 h of after the onset of chest pain. This superiority is attributable to an earlier and more rapid rise in H-FABP than in myoglobin. After thrombolysis, the serum concentrations of H-FABP peak at approximately 4 h after the onset of chest pain, and return to normal values within 24 h. Because of this rapid return of its blood concentration to baseline, H-FABP can contribute to an early biologic diagnosis of post-thrombolysis reperfusion and re-infarction. In absence of renal insufficiency, H-FABP also provides a reliable estimate of infarct size associated with ST segment elevation. When myocardial injury occurs after cardiac surgery, the second peak in H-FABP concentration precedes that of myoglobin, CK-MB or troponins. In addition, H-FABP peaks earlier and is more sensitive than troponins in the detection of subtle myocardial injury in patients presenting with acute coronary syndrome without ST segment elevation, and in patients with severe heart failure, thus offering early prognostic information. Limitations of H-FABP include a limited cardio-specificity, a narrow diagnostic window (20 to 30 h), and a nearly exclusive renal elimination.
心脏型脂肪酸结合蛋白（H-FABP）是一种由132个氨基酸组成的可溶性蛋白，其一般特性与肌红蛋白相似。由于其分子量低（15kd）且位于细胞质中，它构成了心肌损伤后易于释放到循环中的生物标志物。尽管已经开发出各种免疫测定方法来检测H-FABP，但目前很少有方法易于操作、定量且适用于急诊。大多数研究表明，H-FABP的诊断敏感性（即其检测心肌梗死存在的能力）很高，在胸痛发作后3至6小时内就诊的患者中，其诊断敏感性高于肌红蛋白。这种优势归因于H-FABP比肌红蛋白更早、更快地升高。溶栓后，H-FABP的血清浓度在胸痛发作后约4小时达到峰值，并在24小时内恢复到正常水平。由于其血液浓度迅速恢复到基线水平，H-FABP有助于对溶栓后再灌注和再梗死进行早期生物学诊断。在没有肾功能不全的情况下，H-FABP还能可靠地估计与ST段抬高相关的梗死面积。心脏手术后发生心肌损伤时，H-FABP浓度的第二个峰值先于肌红蛋白、肌酸激酶同工酶（CK-MB）或肌钙蛋白。此外，在检测无ST段抬高的急性冠状动脉综合征患者以及严重心力衰竭患者的细微心肌损伤时，H-FABP达到峰值的时间更早，且比肌钙蛋白更敏感，从而提供早期预后信息。H-FABP的局限性包括心脏特异性有限、诊断窗口狭窄（20至30小时）以及几乎完全通过肾脏清除。
