摘要
目的分析血清心脏脂肪酸结合蛋白(H-FABP)、纤溶酶原激活抑制剂-1(PAI-1)、心肌纤维化指标在急性心肌梗死(AMI)中的检测价值。方法选取延安市人民医院2017年6月至2019年6月收治的AMI患者(AMI组)88例,根据冠状动脉病变程度将其分为3个亚组:单支病变组、双支病变组和三支病变组;根据治疗后溶栓是否再通分为2个亚组:溶栓未通组和溶栓再通组;选取同期体检的40例健康人为对照组。比较各组(单支病变组、双支病变组、三支病变组和对照组)左心室功能(LVEF、LVEDV、LVEDD、LVESV、LVESD)及血清H-FABP、PAI-1、心肌纤维化指标(NT-proBNP、PⅢNP、LN、ⅣC、HA)的水平;分析AMI患者血清H-FABP、PAI-1与心肌纤维化指标的相关性;受试者工作曲线(ROC)分析血清H-FABP、PAI-1及心肌纤维化指标对AMI患者的诊断价值;比较溶栓未通组与溶栓再通组治疗前的血清H-FABP、PAI-1及心肌纤维化指标水平。结果与对照组比较,单支病变组、双支病变组和三支病变组的LVEF均低于对照组,但LVEDV、LVEDD、LVESV、LVESD均高于对照组(均P<0.05),且随着冠状动脉病变数目的增加,AMI患者的LVEF减少,但LVEDV、LVEDD、LVESV、LVESD均增加(均P<0.05);单支病变组、双支病变组和三支病变组的血清H-FABP、PAI-1及纤维化指标均显著高于对照组(均P<0.05),且随着冠状动脉病变数目的增加,AMI患者的血清H-FABP、PAI-1、纤维化指标水平亦升高(均P<0.05);AMI患者血清H-FABP与NT-proBNP、PⅢNP、LN、ⅣC及HA的水平之间均呈正相关(r=0.633、0.582、0.515、0.541、0.481,均P<0.05),血清PAI-1与NT-proBNP、PⅢNP、LN、ⅣC及HA的水平之间亦均呈正相关(r=0.599、0.550、0.543、0.570、0.406,均P<0.05)。AMI患者H-FABP、PAI-1及心肌纤维化指标诊断AMI的ROC曲线下面积分别为0.744(95%CI:0.684~0.803)、0.778(95%CI:0.721~0.835)、0.742(95%CI:0.679~0.805),三者联合诊断的ROC曲线下面积为0.852(95%CI:0.803~0.901)。溶栓未通组治疗前血清H-FABP、PAI-1、纤维化指标的水平均显著高于溶栓再通组(均P<0.05)。结论H-FABP、PAI-1、心肌纤维化指标与冠状动脉病变程度及溶栓治疗效果有着密切的关系,在AMI诊断中具有较好的检测价值。
Objective To explore the diagnostic values of heart type-fatty acid binding protein(H-FABP),plasminogen activator inhibitor-1(PAI-1)and myocardial fibrosis indicators in acute myocardial infarction(AMI).Methods A total of 88 AMI patients admitted to Yan’an People’s Hospital from June 2017 to June 2019 were divided into three subgroups:single-vessel disease group,double-vessel disease group and triple-vessel disease group.Furthermore,these patients were divided into failed thrombolysis group and successful thrombolysis group.Forty healthy subjects who received physical examination during the same period were selected as the control group.Left ventricular ejection fraction(LVEF),left ventricular end diastolic volume(LVEDV),left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic volume(LVESV),left ventricular end-systolic diameter(LVESD),serum H-FABP and PAI-1 levels,and myocardial fibrosis indicators(NT-proBNP,PⅢNP,LN,IVC,HA)were measured in both AMI patients and control subjects.The correlations between serum H-FABP and PAI-1 levels and myocardial fibrosis indicators were analyzed in AMI patients.The receiver operating characteristic(ROC)curve was used to analyze the values of H-FABP,PAI-1 and myocardial fibrosis indicators in diagnosis of AMI.Serum levels of H-FABP,PAI-1 and myocardial fibrosis indicators were compared between failed thrombolysis group and successful thrombolysis group.Results Compared with control group,the LVEF decreased but the LVEDV,LVEDD,LVESV,LVESD and serum levels of H-FABP,PAI-1 and myocardial fibrosis indicators increased with the increase of the number of coronary lesions in AMI patients(P<0.05).Serum H-FABP and PAI-1 concentrations were positively correlated with levels of NT-proBNP(r=0.633 and r=0.599,respectively),PⅢNP(r=0.582 and r=0.550,respectively),LN(r=0.515 and r=0.543,respectively),IVC(r=0.541 and r=0.570,respectively)and HA(r=0.481 and r=0.406,respectively)in AMI patients(all P<0.05).The areas under the ROC curve of H-FABP,PAI-1,myocardial fibrosis indicators and their combination for diagnosing AMI were 0.744(95%CI:0.684-0.803),0.778(95%CI:0.721-0.835),0.742(95%CI:0.679-0.805)and 0.852(95%CI:0.803-0.901),respectively.Serum levels of H-FABP,PAI-1 and myocardial fibrosis indicators before treatment in failed thrombolysis group were higher than those in successful thrombolysis group(all P<0.05).Conclusion Serum H-FABP,PAI-1 and myocardial fibrosis indexes are closely related to the degree of coronary artery disease and the efficacy of thrombolytic therapy,and therefore can be used as effective indicators for clinical diagnosis of AMI.
作者
屈丽娜
闫生玲
QU Li-na;YAN Sheng-ling(Department of Vasculocardiology,Yan’an People’s Hospital,Yan’an 716000,China)
出处
《南昌大学学报（医学版）》
CAS
2020年第4期55-60,共6页
Journal of Nanchang University：Medical Sciences
关键词
急性心肌梗死
心脏脂肪酸结合蛋白
纤溶酶原激活物抑制剂-1
心肌纤维化
诊断
acute myocardial infarction
heart type-fatty acid binding protein
plasminogen activator inhibitor-1
myocardial fibrosis
diagnosis
