心脏脂肪酸结合蛋白在心脏直视手术后心肌损伤中判定价值.docVIP

【摘要】 目的 探讨心脏脂肪酸结合蛋白（HFABP）对心脏直视手术后心肌损伤的判定价值。方法 10例行心脏瓣膜置换手术患者，分别于围术期多个时点取挠动脉血，测定血浆HFABP、心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶(CKMB)的水平。结果 血浆HFABP于再灌注后最早达峰值，其峰值与cTnI、CKMB的峰值及主动脉阻断时间呈正相关。结论 HFABP判定心脏直视手术后心肌损伤的早期诊断价值及敏感性优于cTnI、CKMB，对于围术期心肌损伤的诊断、预后及心肌保护效果的评价有重要的价值。 【关键词】 心脏直视手术；心肌损伤；心脏脂肪酸结合蛋白；诊断 　　Early Diagnosis of Myocardial Damage with Heart Fatty Acid-Binding Protein After Open Heart Surgery 　　QIAO Yan-li，CHENG Wei，CHEN Qing-wei，CHEN Zhong-tang 　　（Department Of Cardiac Surgery，The 2nd Hospital Of Shandong Chinese Traditional Medical University，Shandong Jinan 250000，China） 　　Abstract: OBJECTIVE To evaluate the clinical value of heart fatty acid-binding protein（HFABP） in the diagnosis of myocardial damage after open heart surgery. METHODS Ten patients received cardiac valve replacement operation.The radial arterial blood samples were collected serially after reperfusion to measure plasma levels of HFABP,creatine kinase-MB（CKMB） and cardiac troponin-I（cTnI）. RESULTS Plasma HFABP levels peaked earliest after reperfusion. In addition，the maximum plasma HFABP level was predictable immediately after reperfusion .The maximum plasma HFABP level correlated with the maximum plasma CKMB or cTnI level，as well as with the aortic cross-clamp time. CONCLUSION HFABP can be used to evaluate the degree of myocardial damage and myocardial protective effect in open heart surgery during extracorporeal circulation. Measurements of HFABP allow for earlier evaluation of myocardial damage in the acute phase of reperfusion than CKMB and cTnI.Moreover, as indicators for reflecting the myocardial damage,the sensitivity of HFABP are more valuable than CKMB and cTnI. 　　Key words： Open heart surgery；Myocardial damage；Heart fatty acid-binding protein；Diagnosis 　　肌酸磷酸激酶同工酶(CKMB)、心肌肌钙蛋白I(cTnI)被认为是诊断心肌损伤的特异性指标，但由于CKMB、cTnI在心肌损伤后的几小时才达到峰值，因此不利于心肌损伤的早期诊断。心脏脂肪酸结合蛋白(HFABP)是近年发展起来的一项无创、快速、准确、敏感诊断心肌损伤的指标。HFABP是存在于心肌细胞内的小分子蛋白质，心肌损伤时，HFABP可漏出心肌细胞入血、在外周血中可检测出来。本研究动态观察了心脏手术后围术期血浆HFABP、CKMB、cTnI的变化，以探讨HFABP在早期诊断心肌