PROTEIN MARKERS OF CARDIONECROSIS IN THE DYNAMICS OF ACUTE CORONARY SYNDROME

The aim of this study was to compare and analyze the effectiveness of protein markers of myocardial necrosis - heart-type fatty acid-binding protein (H-FABP) and the MB fraction of creatine phosphokinase (CPK-MB) in the dynamics of acute coronary syndrome. Material and methods. A total of 49 patients (57.1 ± 11,0 years) were examined, including 36 male patients (73.5 %) who were admitted to the City Clinical Hospital No. 34 of Novosibirsk with suspected acute coronary syndrome. The content of H-FABP in whole venous blood was evaluated for all patients upon admission to the hospital with the means of the immunochromatographic rapid test «CardioPBFA» (NPO «Biotest», Novosibirsk) with a sensitivity of 15 ng/ml. Determination of CPK-MB was carried out repeatedly in the first 48 hours from the beginning of the clinical manifestations of the disease, using immunochemiluminometric assay. Results and discussion. It was revealed that in patients with myocardial infarction (MI), CPK-MB content after 6-24 hours and also after 24-48 hours from the onset of pain was significantly higher than in patients without MI. H-FABP content 15 ng/ml and more, determined in the majority of patients in the first 6 hours from the onset of pain, was recorded much more often in MI presence than in MI absence. Using partial correlation analysis, it was determined that age influenced the association of MI with CPK-MB 6-24 hours after the onset of pain (which is probably due to the increase in the influence of a number of factors modulating the level of protein cardiac markers with age), and the correlation of MI with CPK-MB in 24-48 hours from the onset of pain did not depend on this factor ( r = 0.322; p = 0.46). In the regression model (χ² = 13.6; p = 0.001) it was revealed that H-FABP content 15 ng/ml and more regardless of age ( p = 0.006) is associated with the presence of MI in the patients, which confirms information about the high significance of identifying this H-FABP level in early diagnosis of myocardial infarction.

protein markers, cardiac necrosis, acute coronary syndrome, dynamics, age

1. Зырянова А.В., Ярохно Н.Н., Николаев К.Ю. Эффективность иммунохроматографического теста определения белка, связывающего жирные кислоты, при ранней дифференциальной диагностике острого коронарного синдрома // Патол. кровообращения и кардиохирургия. 2010. (4). 46-50.

2. Мартынов А.И., Воевода М.И., Арутюнов Г.П., Кокорин В.А., Спасский А.А. Клиническая эффективность ранней диагностики острого инфаркта миокарда с помощью белка, связывающего жирные кислоты // Рос. кардиол. журн. 2012. 17. (3). 7-11.

3. Мартынов А.И., Спасский А.А., Арутюнов Г.П., Велиев С.Н., Воевода М.И., Гафаров В.В., Герасимов С.П., Кокорин В.А., Карпов Р.С., Марков В.А., Михайлов А.А., Николаев К.Ю., Петрова М.М., Рагино Ю.И., Штегман О.А., Шульман В.А., Ярохно Н.Н. Ранняя экспресс-диагностика острого инфаркта миокарда // Терапия. 2015. (3). 13-26.

4. Николаева А.А., Лифшиц Г.И., Штеренталь И.Ш., Пиковская Н.Б., Николаев К.Ю. Особенности нейроэндокринных нарушений регуляции при остром инфаркте миокарда в зависимости от тяжести течения заболевания // Кардиология. 1993. 33. (11). 60-63.

5. Рагозина А.С., Петренко И.В., Урванцева И.А., Горьков А.И., Николаев К.Ю. Оценка уровня кардиомаркеров и функционального состояния миокарда у пациентов с реканализацией хронических окклюзий коронарных артерий при применении нагрузочных доз аторвастатина // Комплекс. пробл. серд.-сосуд. заболеваний. 2018. 7. (1). 29-35.

6. Ярохно Н.Н., Зырянова А.В., Николаев К.Ю. Определение сердечного белка, связывающего жирные кислоты, при остром инфаркте миокарда с помощью качественного иммунохроматографического теста // Мед.-биол. и соц.-психол. пробл. безопасности в чрезв. ситуациях. 2009. (4). 24-27.

7. Bivona G., Agnello L., Bellia C., Lo Sasso B., Ciaccio M. Diagnostic and prognostic value of H-FABP in acute coronary syndrome: Still evidence to bring // Clin. Biochem. 2018. 58. 1-4.

8. Ibánez B., James S., Agewall S., Antunes M.J., Bucciarelli-Ducci C., Bueno H., Caforio A.L.P., Crea F., Goudevenos J.A., Halvorsen S., Hindricks G., Kastrati A., Lenzen M.J., Prescott E., Roffi M., Valgimigli M., Varenhorst C., Vranckx P., Widimský P. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation // Rev. Esp. Cardiol. (Engl. Ed). 2017. 70. (12). 1082-1093.

9. Kokorin V.A., Arefiev M.N., Levchouk N.N., Gordeev I.G. Diagnostic characteristics of the qualitative bedside heart-type fatty acids binding protein tests compared to cardiac troponin assays in patients with suspected acute coronary syndrome // Pol. Arch. Intern. Med. 2018. 128. (10). 623-625.

10. Kozinski M., Krintus M., Kubica J., Sypniewska G. High-sensitivity cardiac troponin assays: From improved analytical performance to enhanced risk stratification // Crit. Rev. Clin. Lab. Sci. 2017. 54. (3). 143-172.

11. Xu L.Q., Yang Y.M., Tong H., Xu C.F. Early diagnostic performance of heart-type fatty acid binding protein in suspected acute myocardial infarction: Evidence from a meta-analysis of contemporary studies // Heart Lung. Circ. 2018. 27. (4). 503-512.