妊娠相关蛋白A-高灵敏度C反应蛋白水平对急性冠脉综合征早期诊断价值的研究

妊娠相关蛋白A\\高灵敏度C反应蛋白水平对急性冠脉综合征早期诊

断价值的研究

【摘要】 目的 探讨PAPP

A、hs

CRP是否可以作为评价ACS患者预

后的血清学指标。方法 本研究病例选自2008年9月至2010年8月在余姚人民医院内科住院并经冠脉造影证实为冠心病的患者82例。所有研究对象均于入院次日清晨采集空腹血，同步测定血清PAPP

A、hs

CRP含量。PAPP

A的CRP

测定采用酶联免疫吸附(enzyme linked immunosorbent assay，ELISA)法，hs

测定采用免疫透射比浊法。结果 所有研究对象在年龄、性别、高血压病史、吸烟史、糖尿病史、体重指数、血脂、血糖等基本临床资料方面差异无统计学意义(P＞0.05)。应用受试者特征曲线(receiver operating characteristic curve，ROC)对PAPP

A、hs

CRP早期诊断ACS及评价12个月预后的情况进行分析，诊断A、hs

CRP的ROC曲线下面积分别为0.860±0.049、

A诊断ACS的灵敏度为81.32％、特异度为

ACS时PAPP

0.763±0.049(均有P＜0.01)，PAPP82.14％，hsA、hs

CRP诊断ACS的灵敏度为74.36％、特异度为65.07％。结论 PAPPCRP是冠心病的独立危险因子，PAPP

A与hs

CRP对ACS患

者早期诊断及12个月预后评价均有重要价值，前者的综合效率高于后者。

【Abstract】 Objective

To investigate whether PAPP

A and hs

CRP can be better markers that

stratify the risks and predict adverse outcomes in patients suffering from acute coronary syndromes. Methods The cases investigated were collected from the patients who hospitalized in the The Poeple’s Hospital of Yuyao city, from September 2008 to Auguest 2010. All the CAD patients had the final diagnosis by CAG.82 patients were collected. The fasting blood preparations of all the subjects were taken in the next morning for the concentration determination of PAPPof PAPP

A were assayed by ELISA, and hs

A and hs

CRP. The levels

CRP were assayed by

immunoturbidimetry. Results The receiver operating characteristic curve(ROC) analysis was used to evaluate and compare the efficacy of biomarkers (PAPP

A and

hsCRP) in early diagnosing ACS. The area under the curve(AUC) of PAPPA

was 0.860±0.049, and the AUC of hsmIU/L, the sensitivity of PAPP

CRP was 0.763±0.049. In the cutoff of 10.23 A in diagnosing ACS was 81.32％, and the

CRP in

A CRP

specificity is 82.14％. In the cutoff of 2.6 mg/L, the sensitivity of hs

diagnosing ACS was 74.36%, and the specificity was 65.07%.Conclusion PAPPmay be an independent risk factor of CAD. The detection of PAPP

A and hs

is useful for the earlier diagnosis and the prognosis evaluation within 12 months of ACS patients, the overall efficiency of PAPP

【Key words】 Pregnancy

associated plasma protein;High

sensitivity

A seems better than hs

CRP.

Creactive Protein;Acute coronarol syndromes

目前，冠心病已成为世界范围内的常见病、多发病，其中急性冠脉综合征(acute coronary syndromes，ACS)是主要致死原因。

1 资料与方法 1.1 一般资料

本研究病例选自2008年9月至2010年8月在余姚人民医院心内科住院并经冠脉造影证实为冠心病的患者82例，平均年龄(64.59±10.47)岁。并签订知情同意书。

1.2 主要诊断标准及排除标准 1.2.1 诊断标准

入选病例诊断标准参照2002年ACC/AHA慢性稳定型心绞痛治疗指南［1］，所有患者均经冠状动脉造影(coronary angiography，CAG)资料证实，即左冠状动脉主干、左冠状动脉前降支(含主要对角支)、左冠状动脉回旋支(含主要边缘支)或右冠状动脉(含后降支)中至少有1支血管狭窄程度≥50％。

1.2.2 排除标准 ①严重肝肾功能不全、严重心功能不全者。② 有冠状动脉搭桥手术史或准备行冠脉搭桥手术者。③ 其他心脏疾病如扩张型心肌病、风湿性心脏病以及周围血管疾病。④ 合并急慢性感染性疾病、恶性肿瘤、自身免疫性疾病及应用免疫抑制剂。⑤合并脑血管意外或其他神经系统疾病。⑥女性妊娠者。⑦发病前1个月内有重大手术史或创伤史。

1.3 标本采集和保存

所有研究对象均于入院次日清晨空腹采血，一次性抽取肘静脉血3 ml于清洁试管中，置于4℃冰箱中静置片刻，血液凝固后30 min内离心。以3000 r/min离心10 min后，抽取上层血清液分装为2份，分别用于PAPP的测定。获取血清标本后迅速置于

70℃低温冰箱冰冻保存。

A和hs

CRP