贺成光,朱筛成

• 1:盐城市妇幼保健院心脏内科

摘要(Abstract)：

目的探讨血清心肌型脂肪酸结合蛋白(H-FABP)在先天性心脏病(CHD)患儿介入治疗前后的变化及影响因素。方法收集2019年1月至2020年6月在盐城市妇幼保健院心脏内科接受封堵器介入治疗的120例CHD患儿资料。根据CHD缺损类型分为室间隔缺损(VSD)组52例,房间隔缺损(ASD)组38例,动脉导管未闭(PDA)组30例,比较患儿手术治疗前后H-FABP、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB型(CK-MB)水平。采用Pearson相关分析法分析H-FABP与cTnI、CK-MB的相关性,采用多因素Logistic回归分析介入治疗后H-FABP升高的影响因素。结果术后15 min～12 h,各组H-FABP、c Tn I和CK-MB水平较术前相比均有显著升高(均P<0.05)。H-FABP均于术后4 h达到峰值水平,c TnI和CK-MB于术后12 h达到峰值水平。H-FABP与c TnI和CK-MB峰值水平均呈显著正相关(r=0.760、0.707,均P<0.001)。多因素Logistic回归分析显示,身体质量指数(BMI)<14 kg/m2、病理类型为非ASD、封堵器直径≥10 mm、封堵器释放次数≥3次、手术时间≥60 min、对比剂总量≥2 ml/kg均是CHD患儿介入治疗后H-FABP升高的独立危险因素(P<0.001)。H-FABP升高组患者的机械通气时间、重症监护病房(ICU)停留时间、血管活性药物使用时间明显长于H-FABP正常组(均P<0.001),H-FABP预测机械通气时间>48 h、ICU停留时间>3 d、血管活性药物使用时间>3d的受试者工作特征曲线下面积分别为0.842、0.817和0.768(均P<0.001)。结论 H-FABP在儿童CHD介入治疗术后早期显著升高,对患儿术后心肌损伤的诊断较传统心肌标志物更具有早期应用价值。其水平升高受到患儿BMI、病理类型、封堵器直径、封堵器释放次数、手术时间和对比剂总量的影响,动态监测H-FABP的水平对于协助判断患儿术后机械通气时间、ICU停留时间、血管活性药物使用时间等早期预后指标具有一定的临床应用价值,有利于及时采取干预措施。

关键词(KeyWords)： 心肌型脂肪酸结合蛋白;先天性心脏病;心肌损伤标志物

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 贺成光,朱筛成

参考文献(References)：

• [1]Hoang TT,Elizabeth G,Roberts AE,et al.The congenital heart disease genetic network study:cohort description[J/OL].Plos One,2018,13(1):e0191319.
• [2]Luscher TF.Outcome of congenital heart disease with modern cardiac care[J].Eur Heart J,2018,39(12):969-971.
• [3]Kahl KG,Fraccarollo D,Winter L,et al.Increased epicardial adipose tissue in young adults with congenital heart disease comorbid with major depressive disorder[J].J Affect Disord,2019,257(1):678-683.
• [4]Atay E,Guzel M,Amanvermez R,et al.Role of Gal-3 and H-FABP in the early diagnosis of acute coronary syndrome[J].Bratisl Lek Listy,2019,120(2):124-130.
• [5]Ye X,He Y,Wang S,et al.Heart-type fatty acid binding protein(H-FABP)as a biomarker for acute myocardial injury and longterm post-ischemic prognosis[J].Acta Pharmacologica Sinica,2018,39(7):1155-1163.
• [6]黎洁雯.先天性心脏病的流行趋势及流行病学分析[J].心血管康复医学杂志,2017,26(1):60-63.
• [7]Duncan WJ,Wong KK,Freedom RM.A criss-cross heart with twisted atrioventricular connections."Perfect Streaming," and double discordance[J].Pediatr Cardiol,2006,27(5):604-607.
• [8]Ilbawi MN,DeLeon SY,Backer CL,et al.An alternative approach to the surgical management of physiologically corrected transposition with ventricular septal defect and pulmonary stenosis or atresia[J].J Thorac Cardiovasc Surg,1990,100(3):410.
• [9]中国医师协会心血管内科分会先心病工作委员会.常见先天性心脏病介入治疗中国专家共识一、房间隔缺损介入治疗[J].介入放射学杂志,2011,20(1):3-9.
• [10]Yao W,Bao Y,Chen Y.Formation of nicrocapsules by ultrasound stimulation for use in remote-controlled drug-eluting stents[J].Med Eng Phys,2018,56(4):42-47.
• [11]Li Y,Chang H,Ni L,et al.Analysis of thrombelastogram-guided medication in patients with coronary heart disease after percutaneouscoronary intervention[J].Exp Ther Med,2019,17(4):3047-3052.
• [12]Sato M,Inoue S,Igarashi A,et al.Heart-type fatty acid binding protein as a prognostic factor in patients with exacerbated chronic obstructive pulmonary disease[J].Respir Investig,2018,56(2):128-135.
• [13]Zhou Y,Liu L,Gao C,et al.Puerarin pre-conditioning on the expression levels of CK-MB,cTnI and inflammatory factors in patients undergoing cardiac valve replacement[J].Exp Ther Med,2019,17(4):2598-2602.
• [14]Agarwal DK,Prasad A,Vinchurkar M,et al.Detection of heart-type fatty acid-binding protein(h-FABP)using piezoresistive polymer microcantilevers functionalized by a dry method[J] Applied.Nanoscience,2018,8(5):1031-1042.
• [15]Crapnell R,Canfarotta F,Czulak J,et al.Thermal detection of cardiac biomarkers H-FABP and ST 2 using a molecularly imprinted nanoparticle-based multiplex sensor platform[J].Acs Sensors,2019,4(10):2838-2845.
• [16]Suresh KP,Devi SA,Badrinath AK,et al.Diagnostic utility of heart type fatty acid binding protein(H-FABP)versus cardiac troponin I in myocardial infarction[J].Adv Med,2018,5(3):514-519.
• [17]Namat RA,Felea MG,Costache II,et al.Heart-type fatty acid-binding protein(H-FABP)in patients with type 2 diabetes beneficiaries of rehabilitation program post coronary artery bypass grafting.revista de chimie bucharest[J].Original Edition,2018,69(10):2712-2717.
• [18]Jo MS,Lee J,Kim SY,et al.Comparison between creatine kinase MB,heart-type fatty acid-binding protein,and cardiac troponin T for detecting myocardial ischemic injury after cardiac surgery[J].Clinica Chimica Acta,2019,488:235-241.
• [19]Zeng XT,Liu TZ,Gong K,et al.The BPSC:A prospective study investigating the clinical effect of interventional therapy and the risk factors for bladder cancer and benign prostatic hyperplasia in Chinese population[J].J Evid Based Med,2018,11(1):64-67.
• [20]Yan W,Zhiliang G,Dehong F,et al.A meta-analysis of the influencing factors for tracheostomy after cervical spinal cord injury[J].BioMed Res Int,2018,2018:5895830.