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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2025, Vol. 18 ›› Issue (05) : 768 -772. doi: 10.3877/cma.j.issn.1674-6902.2025.05.019

论著

外周血心型脂肪酸结合蛋白与重症肺炎患者心肌损伤及预后的相关性
李娜1, 栾亮1,†(), 张苗1, 李萌1, 毛琪1, 李亮2   
  1. 1110016　沈阳，北部战区总医院检验科
    2054500　邢台，河北省平乡县人民医院呼吸内科
  • 收稿日期:2025-07-28 出版日期:2025-10-25
  • 通信作者: 栾亮

Correlation between peripheral blood heart-type fatty acid-binding protein levels and myocardial injury and prognosis in patients with severe pneumonia

Na Li1, Liang Luan1,†(), Miao Zhang1, Meng Li1, Qi Mao1, Liang Li2   

  1. 1Department of Laboratory Medicine, General Hospital of Northern Theater Command, Shenyang 110016, China
    2People′s Hospital, Pingxiang, Hebei Province 054500, China
  • Received:2025-07-28 Published:2025-10-25
  • Corresponding author: Liang Luan
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引用本文：

李娜, 栾亮, 张苗, 李萌, 毛琪, 李亮. 外周血心型脂肪酸结合蛋白与重症肺炎患者心肌损伤及预后的相关性[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(05): 768-772.

Na Li, Liang Luan, Miao Zhang, Meng Li, Qi Mao, Liang Li. Correlation between peripheral blood heart-type fatty acid-binding protein levels and myocardial injury and prognosis in patients with severe pneumonia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(05): 768-772.

目的

分析外周血心型脂肪酸结合蛋白(heart-type fatty acid binding protein, H-FABP)与重症肺炎患者心肌损伤及预后的相关性。

方法

选取2020年4月至2024年4月我院治疗的64例重症肺炎患者为对象，根据预后情况进行分组，死亡者21例为观察组，存活者43例为对照组。检测患者外周血H-FABP、肌钙蛋白Ⅰ，采用Spearman相关性分析外周血H-FABP与肌钙蛋白Ⅰ的相关性；对比两组患者临床资料，采用Logisic回归分析重症肺炎预后的影响因素。应用受试者工作特征曲线(receiver operating characteristic, ROC)分析外周血H-FABP水平对重症肺炎患者预后的预测。

结果

64例患者外周血H-FABP(6.88±1.41)ng/ml；肌钙蛋白Ⅰ为0.28(0.14，0.45)μg/L。Spearman结果显示，外周血H-FABP与肌钙蛋白Ⅰ呈正相关(r＝0.647，P<0.05)；观察组年龄、急性生理学与慢性健康评定标准Ⅱ评分(acute physiology and chronic health evaluation Ⅱ score is acute physiology and chronic health evaluation Ⅱ，APACHEⅡ)(19.33±1.80)分、外周血H-FABP(8.03±0.74)ng/ml、肌钙蛋白Ⅰ 0.47(0.44，0.53)μg/L高于对照组年龄、APACHEⅡ(17.77±2.29)分、外周血H-FABP(6.33±1.32)ng/ml、肌钙蛋白Ⅰ 0.21(0.10，0.28)μg/L(P<0.05)。多因素Logistic回归结果显示，年龄(OR＝1.780，95%CI: 1.166~2.717)、APACHE Ⅱ(OR＝1.779，95%CI：1.104~2.866)、外周血H-FABP(OR＝5.476，95%CI：1.769~16.948)是重症肺炎患者预后的危险因素(P<0.05)；ROC曲线分析显示，年龄、APACHE Ⅱ、外周血H-FABP预测重症肺炎患者预后的曲线下面积(area under the curve, AUC)分别为0.847、0.712、0.873(P<0.05)。

结论

年龄、APACHE Ⅱ、外周血H-FABP水平是重症肺炎患者预后的影响因素，外周血H-FABP水平与心肌损伤存在相关性，对重症肺炎预后患者具有意义。

关键词: 重症肺炎, 心型脂肪酸结合蛋白, 心肌损伤, 预后
Objective

To analyze the correlation between peripheral blood heart-type fatty acid binding protein (H-FABP) and myocardial injury and prognosis in patients with severe pneumonia.

Methods

Sixty-four patients with severe pneumonia treated in our hospital from April 2020 to April 2024 were selected as the subjects. They were grouped according to the prognosis. 21 cases died as the observation group and 43 cases survived as the control group. The H-FABP and troponin Ⅰ in the peripheral blood of the patients were detected, and the correlation between H-FABP and troponin Ⅰ in the peripheral blood was analyzed by Spearman correlation. The general data of the two groups of patients were compared, and Logisic regression was used to analyze the influencing factors of the prognosis of severe pneumonia. The receiver operating characteristic(ROC) curve was applied to analyze the prediction of peripheral blood H-FABP level for the prognosis of patients with severe pneumonia.

Results

The H-FABP in the peripheral blood of 64 patients was (6.88±1.41)ng/ml; Troponin Ⅰ was 0.28 (0.14, 0.45) μg/L. The Spearman results showed that H-FABP in peripheral blood was positively correlated with troponin Ⅰ (r=0.647, P<0.05); Age of the observation group, Acute Physiology and Chronic Health Evaluation Ⅱ score is Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) (19.33±1.80)points, peripheral blood H-FABP (8.03±0.74)ng/ml, troponin Ⅰ 0.47(0.44, 0.53)were higher than the age, APACHEⅡ (17.77±2.29) points, peripheral blood H-FABP (6.33±1.32)ng/ml, and troponin Ⅰ 0.21 (0.10, 0.28) μg/L of the control group (P<0.05). The results of multivariate Logistic regression showed that age (OR=1.780, 95%CI: 1.166~2.717), APACHE Ⅱ(OR=1.779, 95%CI: 1.104~2.866), and peripheral blood H-FABP (OR=5.476, 95%CI: 1.769~16.948) were risk factors for the prognosis of patients with severe pneumonia (P<0.05); ROC analysis showed that age, APACHE Ⅱ, and the area under the curve of peripheral blood H-FABP predicted the prognosis of patients with severe pneumonia. The area under the curve (AUC) values were 0.847, 0.712, and 0.873 respectively (P<0.05).

Conclusion

Age, APACHE Ⅱ, and peripheral blood H-FABP level are the influencing factors for the prognosis of patients with severe pneumonia. There is a correlation between peripheral blood H-FABP level and myocardial injury, which can predict the prognosis of patients with severe pneumonia.

Key words: Severe pneumonia, Heart-type fatty acid binding protein, Myocardial injury, Prognosis
表1 两组重症肺炎患者临床资料比较
临床资料 观察组(n＝21) 对照组(n＝43) t/χ2/Z值 P值
收缩压[mmHg，(±s)] 110.25±10.36 109.67±5.74 0.239 0.813
舒张压[mmHg，(±s)] 71.02±3.33 70.58±2.98 0.513 0.611
心率[次/min，(±s)] 110.32±4.41 109.54±3.64 0.702 0.488
呼吸频率[次/min，(±s)] 29.14±2.02 30.14±2.44 1.734 0.090
吸烟史[n(%)] 4(19.05) 15(34.88) 1.695 0.193
饮酒史[n(%)] 7(33.33) 21(48.84) 1.378 0.240
高血压史[n(%)] 5(23.81) 10(23.26) 0.002 0.961
高血脂症[n(%)] 4(19.05) 11(25.58) 0.336 0.562
糖尿病史[n(%)] 7(33.33) 11(25.58) 0.419 0.517
感染类型[n(%)]     0.517 0.472
细菌感染 16(76.19) 29(67.44)    
其他感染 5(23.81) 14(32.56)    
机械通气[n(%)] 12(57.14) 33(76.74) 2.597 0.107
WBC[×109/L，(±s)] 14.25±2.74 13.74±2.71 1.343 1.181
PLT[×109/L，(±s)] 89.64±8.47 88.97±8.14 0.579 0.563
ALb[g/L，(±s)] 28.88±4.21 29.97±4.28 1.843 0.067
表2 重症肺炎患者预后的多因素Logistic回归分析
影响因素 β 标准误 Wald P值 OR 95%CI
下限 上限
年龄 0.576 0.216 7.131 0.008 1.780 1.166 2.717
APACHE Ⅱ 0.576 0.243 5.608 0.018 1.779 1.104 2.866
外周血H-FABP水平 1.700 0.576 8.700 0.003 5.476 1.769 16.948
肌钙蛋白Ⅰ 0.923 0.612 2.274 0.132 2.516 0.758 8.350
常量 －59.701 17.801 11.248 0.001 － － －
表3 重症肺炎患者预后的ROC曲线分析
变　量 AUC SE 95%CI 特异度(%) 灵敏度(%) P值
年龄 0.847 0.050 0.735~0.925 72.10 95.20 0.000
APACHEⅡ 0.712 0.067 0.585~0.818 67.40 76.20 0.000
外周血H-FABP 0.873 0.043 0.766~0.943 74.40 98.20 0.000
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