| Abstract | Cilj rada.Utvrditi dijagnostičku i prognostičku vrijednost dvaju novih humoralnih biljega nekroze kardiomiocita,srčanog proteina koji veže masne kiseline (H-FABP, prema engleskom„heart fatty acid binding protein“)i BB izoenzima glikogen-fosforilaze(GPBB, prema engleskom„glycogen phosphorylase BB isoenzyme“)u bolesnika s akutnim koronarnim sindromom (AKS), te usporediti sa standardnim biljegom, kardijalnim troponinom I (cTnI).Bolesnici i metode.U prospektivno istraživanje uključeno je200 bolesnika s AKS-om, primljenih u Jedinicuintenzivnog liječenja (Zavodza Kardiovaskularne bolesti,Klinikaza internu medicinu,KBC Rijeka)unutar 12 sati od nastupa boli u prsima. Akutni infarkt miokarda (AIM)je dijagnosticiran u skladu s trenutnim univerzalnim smjernicama. Osim praćenja niza standardnih kliničkih i laboratorijskih varijabli (dob, spol, čimbenici rizika, ranije srčane bolesti, vremenski interval od nastupa boli do prijama, rutinske laboratorijske pretrage), bolesnicima je odreĎivan cTnI, H-FABP i GPBB, u uzorku krvi vaĎenom pri prijamu te nakon 3, 6, 12 i 24 sata. U svih bolesnika odreĎena je krivulja serumske dinamike H-FABP-ai GPBB-ate usporeĎena s dinamikom cTnI-a. Bolesnici su radi daljnje analize podijeljeni u dvije podskupine: a) bolesnike primljene unutar 3 sata od nastupa boli, b) bolesnike primljene nakon 3 sata od nastupa boli. Statistička obrada obuhvatila je odreĎivanje ROCkrivulje(ROC, prema engleskom „Receiver OperatingCharacteristic“)i površine Vpod ROC krivuljom(AUC, prema engleskom „Area Under the Curve“) za tri humoralna biljega (c-statistika), zatim odreĎivanje senzitivnosti, specifičnosti, pozitivne i negativne prediktivne vrijednosti H-FABP-ai GPBB-ate usporedbu s cTnI-om.Rezultati.Od 200 bolesnika s AKS-om92 su primljena unutar tri sata od nastupa boli (46%), a 146 je imalo AIM(73%). Prosječna serumska dinamika H-FABP-ai GPBB-abila je značajno brža od cTnI-a, s ranim vršnim vrijednostima nakon 3 sata od prijama, padom izmeĎu 6 i 12 sati te normalizacijom nakon 24 sata, dok je vršna vrijednost cTnI-abila prisutna nakon 12 sati, s blagim padom te povišenom vrijednošću i nakon 24 sata. Iako je rana senzitivnost H-FABP-a i GPBB-a viša u usporedbi sa senzitivnošću cTnI-a, značajno je viša samo za GPBB (40% prema 24%, p=0.045). Najvećasenzitivnostpostiže se istodobnom kombinacijomdvaju biljega,cTnI-ai GPBB-a(54%, p<0.001). Nakon 3 sata od prijama, senzitivnost sva tri biljega podjednako je visoka. Nadalje, cTnI pokazuje bolju senzitivnost u svim vremenskim intervalima u bolesnika primljenih nakon 3 sata od nastupa AIM-a.Sva tri biljega imaju visoku specifičnost i pozitivnu prediktivnu vrijednost.H-FABP i GPBB nemaju prognostičku vrijednost neovisnog prediktora smrti ubolesnika s AKS-om.Zaključak.Dodatna uporabadvaju novihbiljega, H-FABP-ai GPBB-amože značajno poboljšatilaboratorijsku dijagnostiku u ranoj fazi AKS-a te razlikovanje bolesnika s nestabilnom anginom i onih s infarktom miokarda |
| Abstract (english) | Objectives.To establish diagnostic and prognostic value of two novel humoral markers of myocardial cell necrosis in patients with acute coronary syndrome (ACS), heart fatty acid binding protein (H-FABP) and glycogen phosphorylase BB isoenzyme (GPBB), compared to standard marker, cardiac troponin I (cTnI).Patients and methods.200 patients with ACS, admitted to our coronary care unit within 12 hours from the onset of chest pain, were prospectively included.Acute myocardial infartion (AMI)was diagnosed according to current universal definition and guidelines. Besides series of standard clinical and laboratory variables (age, gender, risk factors, previous heart disease, pain to admission time, routine laboratory tests), cTnI, H-FABP and GPBB were measured from blood samples taken on admission, 3, 6, 12 and24 hours later. H-FABP and GPBB serum dynamics were generated and compared with cTnI curve. For further analysis patients were divided in two subgroups: a) patients admitted within 3 hours from pain onset, b) those admitted later. Statistical analysis included determination of the ROC curve and the area under the curve (AUC) for three markers (c-statistics), determination of the sensitivity, specificity, positive and negative predictive value of H-FABP and GPBB, and comparison with cTnI.Results. Ninety-twoof 200 patients with ACS were admitted within 3 hours from pain onset (46%), and 146 patients had AMI (73%). The mean serum H-FABP and GPBB VIIdynamics were significantly faster, comparing with cTnI, with early peak values after 3 hours from the admission,falling between 6 and 12 hours, and normalization at 24 hours, while mean peak cTnI value was present after 12 hours, remaining positive after 24 hours. The early sensitivity of H-FABP and GPBB was higher compared with cTnI, significantly only for GPBB (40% vs. 24%, p=0.045). The highest sensitivity was found for the combination of cTnI and GPBB (54%, p<0.001). After 3 hours from admission, the sensitivity of all biomarkers was similarly high. Further on, cTnI was better, as well as at all time intervals in patients admitted more than 3 hours after AMI onset. All three biomarkers had similar high specificity and positive predictive value in all patients.H-FABP and GPBB were notindependent predictorsof mortality in patients with ACS.Conclusion.The additional use of H-FABP and GPBB can significantlyimprove laboratory diagnostics in the early phase of ACS and distinguish between patients with unstable angina and those with AMI. |
