刘相应,唐良秋,范文茂,张社兵,陈锦锋,梁家荣,陈云宪,陈兆基

• 1:粤北人民医院心血管内科

摘要(Abstract)：

目的观察直接经皮冠状动脉介入治疗(pPCI)术前、术后血清心型脂肪酸结合蛋白(H-FABP)水平与急性ST段抬高心肌梗死(STEMI)患者术后6个月预后的相关性。方法连续选取粤北人民医院2014年11月至2015年5月STEMI患者共77例,均于发病12 h内行pPCI术,于pPCI术前5 min内及发病后24 h检测血清H-FABP浓度。记录患者一般信息、相关检查化验结果、手术相关情况、心血管疾病危险因素等,随访术后6个月内主要不良心血管事件(MACE)发生情况。结果(1)Pearson相关分析显示:术前血清H-FABP浓度与STEMI患者冠状动脉病变Gensini积分呈正相关(r=0.753,P<0.01);术后血清H-FABP浓度与Gensini积分亦呈正相关(r=0.388,P<0.05),但相关性较差;术前血清H-FABP浓度与STEMI患者心肌梗死范围(MIA)呈正相关(r=0.792,P<0.01);术后血清H-FABP浓度与STEMI患者MIA亦呈正相关(r=0.296,P<0.01),但相关性欠佳。(2)术前以血清H-FABP浓度=106.35 ng/ml为最佳临界值,预测STEMI患者行pPCI术后6个月内发生MACE的敏感度为92.0%,特异度为80.1%,ROC曲线下面积为0.901(95%CI 0.830~0.973,P<0.01)。术后以血清H-FABP浓度=31.85 ng/ml为最佳临界值,预测STEMI患者行pPCI术后6个月内发生MACE的敏感度为88.4%,特异度为52.6%,ROC曲线下面积为0.734(95%CI 0.618~0.851,P=0.002)。(3)随访6个月,共20例患者发生MACE。单因素Cox回归模型发现,术前血清H-FABP浓度(P<0.01)、术后血清H-FABP浓度(P=0.04)均为STEMI患者行pPCI术后6个月内发生MACE的危险因素。多因素Cox回归模型发现,术前血清H-FABP浓度(P=0.008)、糖尿病史(P=0.038)、心肌肌钙蛋白I峰值(P=0.006)、氨基末端B型脑钠肽前体(P=0.021)为STEMI患者行pPCI术后6个月内发生MACE的主要危险因素。结论对于行pPCI的STEMI患者,术前血清H-FABP浓度可能是其术后6个月内发生MACE的独立危险因素。

关键词(KeyWords)： 心型脂肪酸结合蛋白;急性心肌梗死;经皮冠状动脉介入治疗;危险因素;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘相应,唐良秋,范文茂,张社兵,陈锦锋,梁家荣,陈云宪,陈兆基

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