目的:探讨血浆心肌脂肪酸结合蛋白(H-FABP)浓度对急性冠脉综合征(ACS)患者临床预后的预测价值.方法:连续入选172例住院的ACS患者,于出现胸痛6 h内测定H-FABP浓度,并随访1年,以再发心血管事件(包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭及反复心绞痛发作住院)作为研究终点.结果:经过1年随访,共有47例患者发生心血管事件,其中心脏性死亡6例,非致命性心肌梗死9例,非致命性心力衰竭11例,反复心绞痛发作住院21例.心血管事件组H-FABP浓度较无心血管事件组显著增高(P＜0.01);H-FABP浓度增高(＞中位数12.5 μg/L)组患者出现心血管事件明显增加(36例 vs 11例,P＜0.01);Cox比例风险模型多因素逐步分析显示H-FABP浓度增高是ACS患者再发心血管事件的独立危险因子(RR=5.430,P＜0.01;95% CI 2.587-11.398).结论:H-FABP浓度增高的ACS患者再发心血管事件风险显著增加,H-FABP浓度增高可能是ACS患者预后的独立预测因子.%AIM : To investigate the prognostic value of serum concentration of heart - type fatty acid - binding protein( H - FABP ) at early stage of acute coronary syndrome( ACS ).METHODS : This was a prospective observational study with a follow - up of 12 months.The H - FABP was measured within 6 h after onset of chest pain in 172 consecutive patients hospitalized for ACS.The study endpoints were cardiac events, which were defined as cardiac death, subsequent nonfatal acute myocardial infarction( AMI ) , nonfatal heart failure and recurrent angina.RESULTS : During the period of 12 - month follow - up, 47 cardiac events, including 6 cardiac deaths, 9 nonfatal AMIs, 11 nonfatal heart failures and 21 recurrent anginas, were observed.The concentrations of H - FABP in the patients with cardiac events were significantly higher than those in the patients without cardiac events( P ＜0.01 ).Meanwhile. the cardiac events were more prevalent in increased H - FABP( above the median of 12.5 μg/L ) group( 36 events vs 11 events, P ＜ 0.01 ).In a Cox proportional hazards model that adjusted for baseline variables including demographics, clinical characteristics, ST deviation and troponin I, increased H - FABP( above the median of 12.5 μg/L ) was independently associated with cardiac events in all patients[ relative risk( RR ) =5.430, P ＜ 0.01 ;95％ CI 2.587 - 11.398 ].CONCLUSION : Elevation of H - FABP is assoc:iated with an increased risk of c:ardiac events in patients presenting across the spectrum of ACS and is independent of other established clinical risk predictors and hiomarkers.
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