尿肝型脂肪酸结合蛋白水平测定对急性冠状动脉综合征患者的临床意义。
Clinical significance of the measurements of urinary liver-type fatty acid binding protein levels in patients with acute coronary syndrome.
机构信息
Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
出版信息
J Cardiol. 2012 Sep;60(3):168-73. doi: 10.1016/j.jjcc.2012.03.008. Epub 2012 May 31.
BACKGROUND
Recently, much attention has been focused on cardio-renal interaction. Urinary liver-type fatty acid binding protein (U-L-FABP), which is produced in the proximal tubule by renal hypoxia and oxidative stress, has been identified as a useful marker for diagnosis of acute kidney disease and a predictor of future events in chronic kidney disease. However, the clinical significance of U-L-FABP measurements in patients with acute coronary syndrome (ACS) has not been completely evaluated.
METHODS AND RESULTS
This study included 50 consecutive patients with ACS [37 with acute myocardial infarction (AMI) and 13 with unstable angina pectoris (UAP)] and 47 subjects without coronary artery disease (control group). U-L-FABP levels, urinary albumin (U-Alb), and other serum parameters were measured at admission and at 24 h after percutaneous coronary intervention.
RESULTS
U-L-FABP levels in patients with AMI were significantly higher (p=0.0019), than in control subjects, while patients with UAP did not exhibit such an increase. U-L-FABP levels at admission were positively correlated with brain natriuretic protein levels (p=0.001) and duration of hospitalization (p=0.025). At follow-up angiography, patients with restenosis had significantly higher U-L-FABP (p=0.047) and U-Alb levels (p<0.0001) than those without restenosis. After a median follow-up of 42 months, U-L-FABP levels at second measurement in patients with major adverse cardiocerebrovascular events (MACCEs) were significantly higher than those in patients without MACCEs (p=0.028). After adjusting for confounding factors, high U-L-FABP levels at second measurement were found to be independent factors for MACCEs (p=0.019).
CONCLUSIONS
These data suggest that patients with ACS, especially those with AMI, have high U-L-FABP levels, and that U-L-FABP measurements may be useful in identifying high-risk patients for future cardiovascular events after ACS.
背景
近来，人们对心肾交互作用给予了高度关注。尿肝型脂肪酸结合蛋白（U-L-FABP）由肾缺氧和氧化应激在近端肾小管产生，已被确定为急性肾损伤诊断的有用标志物和慢性肾脏病预后的预测因子。然而，急性冠状动脉综合征（ACS）患者中 U-L-FABP 测量的临床意义尚未完全评估。
方法和结果
本研究纳入了 50 例连续 ACS 患者（37 例急性心肌梗死（AMI）和 13 例不稳定型心绞痛（UAP））和 47 例无冠状动脉疾病患者（对照组）。在入院时和经皮冠状动脉介入治疗后 24 小时测量 U-L-FABP 水平、尿白蛋白（U-Alb）和其他血清参数。
结果
AMI 患者的 U-L-FABP 水平明显高于对照组（p=0.0019），而 UAP 患者则未出现这种升高。入院时 U-L-FABP 水平与脑利钠肽水平呈正相关（p=0.001），与住院时间呈正相关（p=0.025）。在随访血管造影中，再狭窄患者的 U-L-FABP（p=0.047）和 U-Alb 水平（p<0.0001）明显高于无再狭窄患者。中位随访 42 个月后，发生主要不良心脑血管事件（MACCEs）患者的第二次测量 U-L-FABP 水平明显高于无 MACCEs 患者（p=0.028）。在校正混杂因素后，第二次测量时高 U-L-FABP 水平被发现是 MACCEs 的独立因素（p=0.019）。
结论
这些数据表明，ACS 患者，尤其是 AMI 患者，U-L-FABP 水平较高，U-L-FABP 测量可能有助于识别 ACS 后发生未来心血管事件的高危患者。
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