Клинико-диагностическое значение сердечного белка, связывающего жирные кислоты (H-FABP), в кардиологической практике

Цель исследования – обобщить и систематизировать современные данные о молекулярных функциях сердечного белка, связывающего жирные кислоты (H-FABP), его роли в ранней диагностике острого коронарного синдрома (ОКС) и прогностической значимости при стабильной ишемической болезни сердца (ИБС) и хронической сердечной недостаточности (ХСН). Материал и методы. Проведен систематический поиск литературы в базах данных PubMed, Scopus, Web of Science, eLibrary за период с 1972 по 2025 г. Ключевые слова: «heart-type fatty acid-binding protein», «H-FABP», «FABP3», «acute myocardial infarction», «stable coronary artery disease», «heart failure», «biomarker», «prognosis». Отобраны оригинальные клинические исследования, метаанализы и систематические обзоры, посвященные диагностической и прогностической ценности H-FABP. Результаты. H-FABP – низкомолекулярный цитозольный белок (15 кДа), обеспечивающий внутриклеточный транспорт длинноцепочечных жирных кислот в кардиомиоцитах. Благодаря быстрому высвобождению при повреждении мембраны он появляется в крови уже через 1–3 ч от начала повреждения кардиомиоцитов, достигая пика к 6–8 ч, что делает его наиболее чувствительным маркером в первые часы острого коронарного синдрома (чувствительность > 90 %, отрицательная прогностическая ценность до 99 %). При ОКС повышение H-FABP (> 8 нг/мл) ассоциировано с 4–5-кратным увеличением риска смерти, повторного инфаркта и сердечной недостаточности в течение года. У пациентов со стабильной ИБС стойкое повышение H-FABP (пороги 2,7–4,5 нг/мл) отражает субклиническое повреждение миокарда вследствие микрососудистой дисфункции, воспаления и метаболического стресса и служит независимым предиктором сердечно-сосудистых событий в сроки до 7 лет (относительный риск (ОР) 2,5–5,0). При ХСН концентрация H-FABP коррелирует с функциональным классом NYHA, а его комбинация с NT-proBNP улучшает стратификацию риска смерти и госпитализаций (ОР до 5,68). При тромбоэмболии легочной артерии (ТЭЛА) уровень H-FABP ≥ 6 нг/мл предсказывает 30-дневные осложнения с ОР 10,04, превосходя тропонины и NT-proBNP. Заключение. H-FABP представляет собой уникальный биомаркер с двойной клинической перспективой: сверхранняя диагностика острого повреждения миокарда и долгосрочная стратификация риска при хронических формах ИБС и ХСН. Для внедрения в широкую практику необходима стандартизация пороговых значений и изучение влияния на терапевтическую тактику.

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