Mazovets O L, Trifonov I R, Katrukha A G, Bereznikova A V, Medvedeva M V, Deev A D, Gratsianksiĭ N A
Kardiologiia. 2008;48(1):24-9.
We tested the hypothesis that serum heart fatty-acid binding protein (FABP), an early marker of myocardial necrosis, is related to prognosis of patients hospitalized because of worsening heart failure (HF).
Sixty nine patients (64% men, age 66.6 +/- 11.0 years) with NYHA class II, III, IV HF (1, 18, and 50 patients, respectively) at hospital admission were followed for 6-12 (mean 11.6 +/- 1.3) months. Forty seven patients (68.1%) had history of myocardial infarction (MI), 56 (81.2%) - hypertension, 15 (21.7%) -- diabetes, and 17 (24.6%) had echocardiographical signs of aortic stenosis. Median left ventricular ejection fraction was 28%. Serum FABP, cardiac troponin I (Tn I) and N-aminoterminal pro brain natriuretic peptide (NT proBNP) were measured within 3 days after admission ( " admission " levels) and 2 weeks later (minimal hospital stay). Manufacturer recommended upper limits of norm (ULN) were 4.0 ng/ml for FABP, 0.35 ng/ml for Tn I, 0.1 ng/ml for NT proBNP.
Median admission FABP was insignificantly higher than level measured 2 weeks later (4.17 vs 4.03 ng/ml, p=0.069). FABP exceeded ULN in 38 (55.1%) patients and in 35 (50.7%) patients at admission and in 2 weeks, respectively (p=0.65). Median admission NT proBNP was significantly higher than 2 weeks level (13.23 vs 6.02 ng/ml, p < 0.0001). Median admission and 2-weeks levels of Tn I were similar and greatly lower than ULN. There were 27 all cause deaths (39.1%) during follow up. Median admission levels of TnI, FABP and NT proBNP were similar in patients who died and survived. Two weeks NT proBNP was significantly higher in patients who died (8.65 vs 3.62 ng/ml, p=0.012). ROC curve derived cut-off levels of FABP and NT proBNP (3.31 ng/ml and 3.5 ng/ml, respectively) were used in univaritate regression analysis. According to this analysis FABP >or= 3.31 ng/ml was related to occurrence of death (OR 3.54; 95% CI 1.03-12.17, p=0.044). FABP and variables with p > 0.1 (age, history of MI and diabetes, regular treatment with nitrates, signs of aortic stenosis, pulmonary rales at admission, and 2 weeks level of NT proBNP >or = cut-off) were included into multivariate logistic regression model. Independent predictors of death were aortic stenosis (OR 31.67; 95% CI 6.11-164.00) and NT proBNP >or= 3.5 ng/ml (OR 5.75; 95%CI 1.69- 19.52).
In this group of patients hospitalized due to worsening of HF admission values of neither FABP nor other biomarkers studied were predictors of death during about 1 year of follow up. FABP level after 2 weeks of hospital stay was related to occurrence of death but as predictor was inferior to NT-proBNP measured at the same time point.
我们检验了如下假设，即血清心脏脂肪酸结合蛋白（FABP）作为心肌坏死的早期标志物，与因心力衰竭（HF）加重而住院患者的预后相关。
69例患者（64%为男性，年龄66.6±11.0岁）在入院时为纽约心脏协会（NYHA）心功能II级、III级、IV级HF患者（分别为1例、18例和50例），随访6 - 12（平均11.6±1.3）个月。47例患者（68.1%）有心肌梗死（MI）病史，56例（81.2%）有高血压，15例（21.7%）有糖尿病，17例（24.6%）有主动脉瓣狭窄的超声心动图表现。左心室射血分数中位数为28%。在入院后3天内（“入院”水平）及2周后（最短住院时间）测定血清FABP、心肌肌钙蛋白I（Tn I）和N末端脑钠肽前体（NT proBNP）。FABP的制造商推荐正常上限（ULN）为4.0 ng/ml，Tn I为0.35 ng/ml，NT proBNP为0.1 ng/ml。
入院时FABP中位数略高于2周后测定水平（4.17对4.03 ng/ml，p = 0.069）。入院时38例（55.1%）患者及2周时35例（50.7%）患者的FABP超过ULN（p = 0.65）。入院时NT proBNP中位数显著高于2周时水平（13.23对6.02 ng/ml，p < 0.0001）。入院时及2周时Tn I的中位数相似且远低于ULN。随访期间有27例全因死亡（39.1%）。死亡患者和存活患者入院时TnI、FABP和NT proBNP的中位数相似。死亡患者2周时的NT proBNP显著更高（8.65对3.62 ng/ml，p = 0.012）。FABP和NT proBNP的ROC曲线得出的截断水平（分别为3.31 ng/ml和3.5 ng/ml）用于单变量回归分析。根据该分析，FABP≥3.31 ng/ml与死亡发生相关（OR 3.54；95%CI 1.03 - 12.17，p = 0.044）。FABP以及p>0.1的变量（年龄、MI和糖尿病病史、硝酸盐常规治疗、主动脉瓣狭窄体征、入院时肺部啰音以及2周时NT proBNP≥截断值）被纳入多变量逻辑回归模型。死亡的独立预测因素是主动脉瓣狭窄（OR 31.67；95%CI 6.11 - 164.00）和NT proBNP≥3.5 ng/ml（OR 5.75；95%CI 1.69 - 19.52）。
在这组因HF加重而住院的患者中，入院时FABP及其他所研究的生物标志物的值均不是约1年随访期间死亡的预测指标。住院2周后的FABP水平与死亡发生相关，但作为预测指标不如同一时间点测定的NT - proBNP。
