Heart Fatty Acid Binding Protein Sebagai Biomarker Sindroma Koroner Akut

I Nyoman Gde Sudana, dr. Setyawati, SpPK(K) ; dr. Usi Sukorini, Mkes.,SpPK(K)

2015 | Tesis | S2 Ilmu Patologi Klinik

Latar Belakang: Heart fatty acid binding protein (H-FABP) adalah protein transporter intraseluler yang mengangkut fatty acid dari darah ke sel otot jantung, protein sitoplasma dengan berat molekul kecil, dikeluarkan lebih cepat ke aliran darah ketika terjadi kerusakan sel otot jantung. Kadar H-FABP muncul sangat awal 1-3 jam setelah onset sindrom koroner akut (SKA), puncak pada jam ke 6-8, dan kembali normal dalam 24 jam. Tujuan penelitian ini adalah untuk menentukan nilai cut off Heart Fatty Acid Binding Protein yang memiliki sensitivitas minimal 90% pada pasien sindroma koroner akut di RSUP Dr. Sardjito Yogyakarta. Metode: Penelitian dengan desain cross sectional terhadap 75 pasien secara konsekutif yang datang ke IGD dengan keluhan nyeri dada suspek SKA. Pengukuran H-FABP menggunakan metode immunoturbitimetric assay. Analisis Receiver operating characteristic (ROC) untuk mengetahui nilai cut off, sensitivitas dan spesifisitas. Hasil : Keseluruhan 75 pasien (59 kelompok SKA dan 16 kelompok non SKA) berpartisipasi dalam penelitian ini, dominan adalah laki-laki (64 [76,2%]). Pasien dengan AMI, 20 (26,7%) STEMI dan 21 (28%) NSTEMI. Nilai cut off optimal H-FABP adalah 15 ng/mL dengan sensitivitas dan spesifisitas dalam mendiagnosis SKA 98,31% (95%CI 90-100) dan 93,75% (95%CI 86-99). Nilai areas under curve (AUC) H-FABP mendiagnosis membedakan dari non SKA 0,983 (95%CI 0,927-0,999). Simpulan: Nilai cut off H-FABP 15 ng.mL dengan nilai sensitivitas 98,31% dan spesifisitas 93,75% dalam mendiagnosis SKA di RSUP Dr. Sardjito Yogyakarta.

Background Heart-fatty acid-binding protein (H-FABP) is a membrane-bound protein that facilitates transport of fatty acids from the blood into the heart. It is a low molecular weight cytoplasmic protein. Because of its small size and location, it is released rapidly into the blood following myocardial damage. H-FABP levels rise as early as 1-3 hours after the onset of Acute Coronary Syndromes, peak at 6-8 hours, and return to normal within 24 hours. The purpose of this study is to determine the cut-off value of Heart Fatty Acid Binding Protein has a sensitivity of at least 90% in patients with acute coronary syndrome in the Dr. Sardjito Hospital Yogyakarta. Methods: We undertook a cross sectional evaluation of 75 consecutive patients admitted with acute chest pain suggestive of acute coronary syndromes (ACS). H-FABP was measured by using immunoturbidimetric assay methods. Receiver operating characteristic (ROC) analysis were calculated for the cut off point, sensitivity and specificity estimates. Results: A total of 75 patients (59 in the ACS group and 16 in the control group) were included in this study, and the majority of the SKA group (64 [76,2%]) were men. Of the patients with AMI, 20 (26,7%) had an ST-elevation myocardial infarction and the rest (21 [28%]) had a non ST-elevation myocardial infarction. The optimized cut-off obtained for h-FABP was 15 ng/mL, providing a sensitivity and specificity of the H-FABP assay for detecting ACS were 98,31 (95% CI 90 to 100) and 93,75% (95% CI 86 to 99), respectively. The areas under the receiver operator characteristic (ROC) curves to distinguish ACS from non-ACS were 0.983 (95% CI: 0.927-0.999) for H-FABP. Conclusions: The optimized cut-off obtained for H-FABP was 15 ng/mL, providing 98,31% to sensitivity and 93,75% to specificity for detecting ACS in the Dr. Sardjito hospital Yogyakarta.

Kata Kunci : Heart fatty acid binding protein, troponin I, sindroma koroner akut, biomarker, immunoturbidimetric assay.