心型脂肪酸结合蛋白与慢性心功能不全相关性临床研究.docVIP

心型脂肪酸结合蛋白与慢性心功能不全相关性临床研究 　　【摘要】 目的：研究心型脂肪酸结合蛋白（H-FABP）对慢性充血性心力衰竭（CHF）危险程度及预后的影响。方法：CHF组纳入80例CHF患者，按照纽约心功能分级标准分为心功能Ⅱ、Ⅲ、Ⅳ三个亚组，对照组为65例健康体检者。两组均检测血浆H-FABP、NT-proBNP、cTnI、CKMB浓度，并做统计学分析。随访时间至少为1年，统计心脏不良事件的发生率。结果：CHF各组与对照组比较H-FABP、NT-proBNP、cTnI差异均有统计学意义（P0.05）。H-FABP阳性组、NT-proBNP阳性组死亡例数比例相对较高，但与其余两组比较差异无统计学意义（P0.05）；H-FABP阳性组再入院率及顽固性心衰发生率均比cTnI阳性组、CKMB阳性组高，差异均有统计学意义（P0.05）。多因素logistic分析发现NT-proBNP、H-FABP与全因死亡率相关（P0.05）。结论：H-FABP能够对CHF危险程度进行分级，有利于评估远期预后。 　　【关键词】 心型脂肪酸结合蛋白； 慢性心功能不全； 危险程度； 预后 　　【Abstract】 Objective：To investigate the relationship of heart-type fatty acid- binding protein （H-FABP） and chronic congestive heart failure （CHF）.Method：The CHF group included 80 patients with CHF，they were divided into NYHA Ⅱ， Ⅲ and Ⅳ three subgroups. The control group were 65 healthy person.Serum concentrations of H-FABP，NT-proBNP and cTnI of two groups were measured. Followed-up at least a year， the major adverse cardiac events were recorded. Result：Serum concentrations of H-FABP，NT-proBNP and cTnI of CHF group were higher than control group，the differences were statistically significant（P0.05）.The deaths proportion of H-FABP positive group and NT-proBNP positive group were higher than the rest two groups，but had no statistical difference（P0.05）.The incidence of readmission and refractory heart failure in H-FABP positive group were higher than cTnI group and CKMB group，the differences were statistically significant （P0.05）.Multiariable logistic regression analysis found that NT-proBNP and H-FABP associated with all-cause mortality（P0.05）.Conclusion：The detection of H-FABP can be help for assessment risk stratification and prognosis for patients with CHF. 　　【Key words】 Heart-type fatty acid- binding protein； Chronic congestive heart failure； Risk stratification； Prognosis 　　慢性充血性心力衰竭（Chronic congestive heart failure，CHF）是各种心脏疾病的终末阶段，其基本病理机制为心室重构、心肌纤维化[1]。CHF患者可以发生心肌损伤，其具体机制尚不完全明确，推断可能与启动心肌细胞的凋亡或坏死程序有关[2]。N末端脑钠肽（NT-pro BNP）是目前临床上唯一用来评估心功能严重程度的标志物，但具有一定的局限性，严重心功能不全或肥胖患者可能正常，于是