脂肪组织脂肪酸结合蛋白在急性ST段抬高型心肌梗死患者治疗中指导价值研究
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摘要
目的探讨脂肪组织脂肪酸结合蛋白(A-FABP)在急性ST段抬高型心肌梗死(STEMI)患者治疗中的指导价值。方法选取自2013年8月至2017年8月行直接经皮冠状动脉介入治疗的190例STEMI患者为研究对象。根据A-FABP水平不同,将所有患者分为低水平组(A-FABP<30 ng/ml,n=57)、中水平组(A-FABP 30～40 ng/ml,n=74)与高水平组(A-FABP≥40 ng/ml,n=59)3组。比较3组患者各项心功能指标、炎症因子水平、主要不良心脑血管事件(MACCE)和Syntax积分。分析A-FABP水平与心功能指标、炎症因子水平及MACCE之间的相关性。结果高水平组的左室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)均显著高于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05);高水平组左室射血分数(LVEF)显著低于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05)。高水平组肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-10水平均显著高于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05);高水平组心肌肌钙蛋白Ⅰ(cTnⅠ)及肌酸磷酸激酶同工酶(CKMB)水平显著低于低水平组及中水平组,组间比较,差异均有统计学意义(P<0.05)。高水平组MACCE发生率显著高于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05)。高水平组的Syntax积分显著高于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05)。A-FABP水平与LVEDD、LVEDV、IL-6、IL-10、cTnⅠ、CKMB、MACCE、Syntax积分呈正相关(P<0.05);A-FABP水平与LVEF呈负相关(P<0.05)。结论 A-FABP参与了整个心肌梗死的发生及发展过程,能够间接的反映出心肌梗死患者的病情、危险程度,与患者的心室重构之间存在相关性。
Objective To investigate the value of adipocyte fatty acid binding protein(A-FABP)in the treatment of STEMI patients.Methods A retrospective study was performed on 190 cases of STEMI patients who were admitted and underwent percutaneous coronary intervention(PCI)from August 2013 to August 2017.According to the different levels of A-FABP,all patients were divided into three groups:the low level group(A-FABP less than 30 ng/ml,n=57),the middle level group(A-FABP 30-40 ng/ml,n=74)and the high level group(A-FABP more than 40 ng/ml,n=59).All cardiac function indicators,inflammatory factors,major cardiovascular events(MACCE)and Syntax score were compared in the three groups.The correlation between A-FABP level and cardiac function indexes,inflammatory factors and MACCE were analyzed.Results The left ventricular end diastolic diameter(LVEDD)and left ventricular end diastolic volume(LVEDV)of the high level group were significantly higher than those of the middle level group and the low level group,and the differences were statistically significant(P<0.05);left ventricular ejection fraction(LVEF)of the high level group was significantly lower than that of the middle level group and the low level group(P<0.05).Tumor necrosis factor-α(TNF-α),interleukin(IL)-6 and IL-10 levels in the high level group were significantly higher than those in the middle level group and the low level group(P<0.05);the levels of cardiac troponin Ⅰ(cTnⅠ)and creatine phosphokinase isoenzyme(CKMB)in the high level group were significantly lower than those in the low level group and the middle level group(P<0.05).The overall incidence of MACCE in the high level group was significantly higher than that in the middle level group and the low level group(P<0.05).The Syntax score of the high level group was significantly higher than that of the middle level group and the low level group(P<0.05).A-FABP level was positively correlated with LVEDD,LVEDV,IL-6,IL-10,cTnⅠ,CKMB,MACCE and Syntax score(P<0.05);A-FABP level was negatively correlated with LVEF(P<0.05).Conclusion A-FABP is involved in the occurrence and development of the entire myocardial infarction,which can indirectly reflect the condition and risk degree of the patients with myocardial infarction and is correlated with the patients′ ventricular remodeling.
Objective To investigate the value of adipocyte fatty acid binding protein(A-FABP)in the treatment of STEMI patients.Methods A retrospective study was performed on 190 cases of STEMI patients who were admitted and underwent percutaneous coronary intervention(PCI)from August 2013 to August 2017.According to the different levels of A-FABP,all patients were divided into three groups:the low level group(A-FABP less than 30 ng/ml,n=57),the middle level group(A-FABP 30-40 ng/ml,n=74)and the high level group(A-FABP more than 40 ng/ml,n=59).All cardiac function indicators,inflammatory factors,major cardiovascular events(MACCE)and Syntax score were compared in the three groups.The correlation between A-FABP level and cardiac function indexes,inflammatory factors and MACCE were analyzed.Results The left ventricular end diastolic diameter(LVEDD)and left ventricular end diastolic volume(LVEDV)of the high level group were significantly higher than those of the middle level group and the low level group,and the differences were statistically significant(P<0.05);left ventricular ejection fraction(LVEF)of the high level group was significantly lower than that of the middle level group and the low level group(P<0.05).Tumor necrosis factor-α(TNF-α),interleukin(IL)-6 and IL-10 levels in the high level group were significantly higher than those in the middle level group and the low level group(P<0.05);the levels of cardiac troponin Ⅰ(cTnⅠ)and creatine phosphokinase isoenzyme(CKMB)in the high level group were significantly lower than those in the low level group and the middle level group(P<0.05).The overall incidence of MACCE in the high level group was significantly higher than that in the middle level group and the low level group(P<0.05).The Syntax score of the high level group was significantly higher than that of the middle level group and the low level group(P<0.05).A-FABP level was positively correlated with LVEDD,LVEDV,IL-6,IL-10,cTnⅠ,CKMB,MACCE and Syntax score(P<0.05);A-FABP level was negatively correlated with LVEF(P<0.05).Conclusion A-FABP is involved in the occurrence and development of the entire myocardial infarction,which can indirectly reflect the condition and risk degree of the patients with myocardial infarction and is correlated with the patients′ ventricular remodeling.
引文
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[16] Wang Y,Chen H,Han D,et al.Correlation of the A-FABP gene polymorphism and mRNA expression with intramuscular fat content in three-yellow chicken and hetian-black chicken[J].Anim Biotechnol,2017,28(1):37-43.
[17] 涂芊茜,赵宁,徐淼,等.急性心肌梗死患者血清心型脂肪酸结合蛋白水平与心功能参数的相关性[J].中国老年学杂志,2016,36(20):5037-5039.
[18] 韩斌,郑文香,曹新河,等.脓毒血症时心肌损伤分子细胞层发病机制及生物标志物研究进展[J].河北医药,2017,39(19):3011-3015.
[19] 王晓旭,王晓楠,王文超,等.川崎病患儿血清脑利钠肽、心型脂肪酸结合蛋白的变化及其与心功能的关系[J].中华实用儿科临床杂志,2017,32(9):705-707.
[2] 朱祖福.缺血性脑卒中急性期血清缺血修饰蛋白、脂肪酸结合蛋白水平的变化及与神经功能缺损程度的关系[J].中国老年学杂志,2016,36(14):3436-3438.
[3] 王江元,刘天明,袁宝山等.H-FABP和cTnT在老年心绞痛及心肌梗死中的应用价值[J].中国老年学杂志,2016,36(2):314-316.
[4] Panduru NM,Forsblom C,Saraheimo M,et al.Urinary liver-type fatty acid binding protein is an independent predictor of stroke and mortality in individuals with type 1 diabetes[J].Diabetologia,2017,60(9):1782-1790.
[5] 蔡玲,范雪梅,孙健,等.血清H-FABP和cTnT水平联合测定在急性心肌梗死诊断中的作用[J].临床心血管病杂志,2017,33(7):643-645.
[6] 詹景冬,李颖.脂肪酸结合蛋白在急性心肌梗死诊断中的应用[J].中国地方病防治杂志,2017,32(5):536-537.
[7] 刘宁,刘昊,王志军,等.丹参滴丸联合ARB对老年慢性心衰患者血清NT-proBNP、H-FABP以及Nexilin含量影响研究[J].中华中医药学刊,2016,34(1):251-254.
[8] 柳彩侠,卜林,孙东.慢性心肾综合征患者外周血TnⅠ、NT-proBNP、H-FABP及MYO水平观察[J].山东医药,2017,57(7):27-30.
[9] Wang W,Chu HJ,Liang YC,et al.FABP5 correlates with poor prognosis and promotes tumor cell growth and metastasis in cervical cancer[J].Tumour Biol,2016,37(11):14873-14883.
[10] 齐洪娜,张建军,何佳起,等.心型脂肪酸结合蛋白和N-末端脑钠肽前体在脓毒症心肌损伤中的变化及意义[J].实用医学杂志,2016,32(17):2857-2860.
[11] 李丹丹,李雯莉,高冉冉,等.心肌脂肪酸结合蛋白在脓毒症临床预后的预测价值研究[J].中华急诊医学杂志,2016,25(11):1443-1448.
[12] 刘晓婷,王霞,李佳,等.心型脂肪酸结合蛋白与老年人急性重度一氧化碳中毒心肌损伤的相关性[J].中国老年学杂志,2016,36(6):1431-1433.
[13] Schroeder F,McIntosh AL,Martin GG,et al.Fatty acid binding protein-1 (FABP1)and the human FABP1 T94A variant:roles in the endocannabinoid system and dyslipidemias[J].Lipids,2016,51(6):655-676.
[14] 周洪,綦俊,张奇,等.心肌型脂肪酸结合蛋白联合APACHEⅡ评分对急性肺栓塞病情严重程度及预后的评估价值[J].中华胸心血管外科杂志,2017,33(4):204-207.
[15] 王庆丽,宋成伟,卢颖,等.血清内脏脂肪素、脂肪细胞型脂肪酸结合蛋白对冠状动脉粥样硬化程度的评估价值[J].山东医药,2016,56(17):41-43.
[16] Wang Y,Chen H,Han D,et al.Correlation of the A-FABP gene polymorphism and mRNA expression with intramuscular fat content in three-yellow chicken and hetian-black chicken[J].Anim Biotechnol,2017,28(1):37-43.
[17] 涂芊茜,赵宁,徐淼,等.急性心肌梗死患者血清心型脂肪酸结合蛋白水平与心功能参数的相关性[J].中国老年学杂志,2016,36(20):5037-5039.
[18] 韩斌,郑文香,曹新河,等.脓毒血症时心肌损伤分子细胞层发病机制及生物标志物研究进展[J].河北医药,2017,39(19):3011-3015.
[19] 王晓旭,王晓楠,王文超,等.川崎病患儿血清脑利钠肽、心型脂肪酸结合蛋白的变化及其与心功能的关系[J].中华实用儿科临床杂志,2017,32(9):705-707.