循环脂肪酸结合蛋白4（FABP4）是急性缺血性脑卒中患者的一种新型预后生物标志物。
Circulating FABP4 (Fatty Acid-Binding Protein 4) Is a Novel Prognostic Biomarker in Patients With Acute Ischemic Stroke.
作者信息
Tu Wen-Jun, Zeng Xian-Wei, Deng Aijun, Zhao Sheng-Jie, Luo Ding-Zhen, Ma Guo-Zhao, Wang Hong, Liu Qiang
机构信息
From the Institute of Radiation Medicine, China Academy of Medical Science and Peking Union Medical College, Tianjin, China (W.-J.T., Q.L.); Department of Neurology, China Rehabilitation Research Center, Beijing, China (W.-J.T., S.-J.Z.); School of Rehabilitation Medicine, Capital Medical University, Beijing, China (W.-J.T., H.W.); Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, China (X.-W.Z., A.D.); and Department of Neurology, Provincial Hospital of Shandong University, Jinan, China (D.-Z.L., G.-Z.M.).
出版信息
Stroke. 2017 Jun;48(6):1531-1538. doi: 10.1161/STROKEAHA.117.017128. Epub 2017 May 9.
BACKGROUND AND PURPOSE
FABP4 (fatty acid-binding protein 4) is an intracellular lipid chaperone involved in coordination of lipid transportation and atherogenesis. This study aimed at observing the effect of FABP4 on the 3-month outcomes in Chinese patients with acute ischemic stroke.
METHODS
In a prospective multicenter observational study, serum concentrations of FABP4 were on admission measured in plasma of 737 consecutive patients with acute ischemic stroke. Serum concentrations of FABP4, National Institutes of Health Stroke Scale score, and conventional risk factors were evaluated to determine their value to predict functional outcome and mortality within 3 months.
RESULTS
During follow-up, an unfavorable functional outcome was found in 260 patients (35.3%), and 94 patients (12.8%) died. In multivariate models comparing the third and fourth quartiles to the first quartile of FABP4, the concentrations of FABP4 were associated with poor functional outcome and mortality. Compared with the reference category (Q1-Q3), the concentrations of FABP4 in Q4 had a relative risk of 4.77 (95% confidence interval [CI], 2.02-8.15; <0.001) for poor functional outcome and mortality (odds ratio, 6.15; 95% CI, 3.43-12.68) after adjusting for other significant outcome predictors in univariate logistic regression analysis. Receiver-operating characteristic curves to predict poor functional outcome and mortality demonstrated areas under the curve of FABP4 of 0.78 (95% CI, 0.75-0.82) and 0.83 (95% CI, 0.79-0.88), which improved the prognostic accuracy of National Institutes of Health Stroke Scale score with combined areas under the curve of 0.83 (95% CI, 0.76-0.89; <0.01) and 0.86 (95% CI, 0.81-0.92), respectively.
CONCLUSIONS
Data show that FABP4 is a novel independent prognostic marker improving the currently used risk stratification of stroke patients.
背景与目的
脂肪酸结合蛋白4（FABP4）是一种细胞内脂质伴侣蛋白，参与脂质转运和动脉粥样硬化的协调过程。本研究旨在观察FABP4对中国急性缺血性脑卒中患者3个月预后的影响。
方法
在一项前瞻性多中心观察性研究中，检测了737例连续急性缺血性脑卒中患者入院时血浆中FABP4的血清浓度。评估FABP4的血清浓度、美国国立卫生研究院卒中量表评分及传统危险因素，以确定它们预测3个月内功能预后和死亡率的价值。
结果
随访期间，260例患者（35.3%）出现不良功能预后，94例患者（12.8%）死亡。在多变量模型中，将FABP4的第三和第四四分位数与第一四分位数进行比较，FABP4浓度与不良功能预后和死亡率相关。与参考类别（第一至第三四分位数）相比，在单变量逻辑回归分析中对其他显著的预后预测因素进行校正后，第四四分位数中FABP4浓度出现不良功能预后和死亡的相对风险为4.77（95%置信区间[CI]，2.02 - 8.15；P<0.001）（比值比，6.15；95%CI，3.43 - 12.68）。预测不良功能预后和死亡的受试者工作特征曲线显示，FABP4的曲线下面积分别为0.78（95%CI，0.75 - 0.82）和0.83（95%CI，0.79 - 0.88），这分别提高了美国国立卫生研究院卒中量表评分的预后准确性，联合曲线下面积分别为0.83（95%CI，0.76 - 0.89；P<0.01）和0.86（95%CI，0.81 - 0.92）。
结论
数据表明，FABP4是一种新型独立预后标志物，可改善目前对脑卒中患者的风险分层。
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