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血清心型脂肪酸结合蛋白、游离脂肪酸对老年冠心病患者经皮冠状动脉介入术后心肌损伤的诊断价值

Diagnostic value of combined detection of serum heart-typefatty acid binding protein as well as non-esterified fatty acid for postoperative myocardial injury after percutaneous coronary intervention in elderly patients with coronary heart disease

    摘要
  • 摘要:
      目的  探讨血清心型脂肪酸结合蛋白（H-FABP）、游离脂肪酸（NEFA）对老年冠心病患者经皮冠状动脉介入（PCI）术后心肌损伤的诊断价值。
      方法  选取104例行PCI手术的老年冠心病患者作为研究对象，根据治疗3个月后是否发生心肌损伤，将患者分为心肌损伤组32例和心肌未损伤组72例，收集所有患者的临床资料。采用酶联免疫吸附法（ELISA）检测患者血清H-FABP、NEFA水平；采用Gensini评分法评估患者术前冠状动脉病变程度；采用Pearson法分析H-FABP、NEFA水平与肌钙蛋白I（cTnI）的相关性；采用受试者工作特征（ROC）曲线评估血清H-FABP、NEFA单独及联合诊断冠心病患者PCI术后心肌损伤的价值。
      结果  心肌损伤组术前Gensini评分和cTnI、低密度脂蛋白胆固醇（LDL-C）、H-FABP、NEFA水平均高于心肌未损伤组，发病至救治时间长于心肌未损伤组，高密度脂蛋白胆固醇（HDL-C）水平低于心肌未损伤组，差异有统计学意义（P < 0.05）。心肌损伤患者血清H-FABP、NEFA水平均与cTnI水平呈正相关（P < 0.05）。ROC曲线显示，血清H-FABP、NEFA水平诊断冠心病患者PCI术后心肌损伤的曲线下面积（AUC）分别为0.873、0.816，敏感度分别为82.90%、71.40%，特异性分别为90.30%、90.30%；血清H-FABP联合NEFA诊断冠心病患者PCI术后心肌损伤的AUC为0.941，敏感度、特异性分别为94.30%、90.30%。
      结论  冠心病PCI术后心肌损伤患者血清H-FABP、NEFA呈高表达，H-FABP、NEFA可预估冠心病患者PCI术后心肌损伤，且二者联合的诊断价值较好。

     

    Abstract:
      Objective  To explore the diagnostic value of serum heart-type fatty acid binding protein (H-FABP) and non-esterified fatty acid (NEFA) for myocardial injury after percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease.
      Methods  A total of 104 patients with coronary heart disease who underwent PCI were selected as research objects. According to whether myocardial injury occurred after 3 months of treatment, they were divided into myocardial injury group (32 cases) and non-myocardial injury group (72 cases). The clinical information of all patients were collected. Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum H-FABP and NEFA levels; the Gensini scoring method was used to assess the degree of coronary artery disease before surgery; Pearson method was used to analyze the correlations between H-FABP, NEFA levels and troponin I (cTnI); the receiver operating characteristic (ROC) curve was used to evaluate the values of detection of serum H-FABP level or NEFA level alone or their combination in diagnosing myocardial injury in patients with coronary heart disease after PCI.
      Results  Compared with the non-myocardial injury group, the preoperative Gensini score, cTnI, low-density lipoprotein cholesterol (LDL-C) levels, H-FABP level, and NEFA level were higher in the myocardial injury group, the time from onset to treatment was longer, the high-density lipoprotein cholesterol (HDL-C) level was lower (P < 0.05). Serum H-FABP level and NEFA level in patients with myocardial injury were positively correlated with cTnI (P < 0.05). ROC curve showed that the area under the curve (AUC) of serum H-FABP and NEFA levels in the diagnosis of myocardial injury after PCI in patients with coronary heart disease was 0.873 and 0.816, respectively, and the sensitivity was 82.90% and 71.40%, respectively and the specificity was 90.30% and 90.30% respectively. The AUC of the H-FABP combined with NEFA in diagnosis of myocardial injury in patients with coronary heart disease after PCI was 0.941, and the sensitivity and specificity were 94.30% and 90.30%, respectively.
      Conclusion  The serum H-FABP and NEFA are highly expressed in patients with myocardial injury after PCI for coronary heart disease. H-FABP and NEFA can predict myocardial injury in patients with coronary heart disease after PCI, and their combined diagnosis value is better.

     

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