急性冠状动脉综合征患者外周血妊娠相关血浆蛋白A水平的变化  

Changes of pregnancy-associated plasma protein-A levels in patients with acute coronary syndrome

作　　者：孙玉发[1] 范利[1] 蒋知新[2] 郭广宏[3] 原新红[3] 冯胜强[4] 缴富斌[4] 谢淑华[4] 

机构地区：[1]解放军总医院南楼心内科,北京市100853 [2]解放军第三〇五医院检验科,北京市100017 [3]解放军总医院生化科,北京市100853 [4]解放军总参谋部警卫局保健处,北京市100000

出　　处：《中国临床康复》2006年第44期44-46,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:分析外周血妊娠相关血浆蛋白A水平与急性冠状动脉综合征的关系。方法:选择解放军总医院2004-10/2005-02住院的急性心肌梗死、不稳定型心绞痛、稳定型心绞痛患者及同期在解放军第三○五医院门诊查体的健康志愿者各30例,应用酶联免疫吸附方法测定各组的外周血妊娠相关血浆蛋白A,同时测定各组超敏C-反应蛋白、总胆固醇、低密度脂蛋白胆固醇、三酰甘油及心肌梗死和不稳定型心绞痛患者的肌酸激酶、肌酸激酶同工酶和肌钙蛋白T水平。应用SPSS12.0软件进行直线回归和多元线性回归分析,分析妊娠相关血浆蛋白A、超敏C-反应蛋白水平与心肌酶学标志物的关系,以及妊娠相关血浆蛋白A与冠状动脉粥样硬化性心脏病危险因素的关系。结果:120例受试者全部进入结果分析。①心肌梗死组和不稳定型心绞痛组妊娠相关血浆蛋白A水平显著高于稳定型心绞痛组和健康对照组[(6.23±7.38),(5.74±7.45),(1.23±0.70),(0.87±0.57)mU/L,P<0.05],前2组组间及后2组组间比较差异不显著(P>0.05)。②在心肌梗死与不稳定型心绞痛患者,妊娠相关血浆蛋白A与超敏C-反应蛋白水平呈直线相关(R2=0.285,0.779,P<0.01)。③急性冠状动脉综合征患者外周血妊娠相关血浆蛋白A水平与年龄、体质量指数、血脂、白细胞、吸烟等危险因素无关(P>0.05),与冠状动脉狭窄病变支数无关(P>0.05)。④心肌梗死患者外周血妊娠相关血浆蛋白A水平与心肌酶学指标间无相关性(P>0.05)。结论:急性冠状动脉综合征患者外周血妊娠相关血浆蛋白A水平明显升高,其升高水平与炎症标志物超敏C-反应蛋白相关。提示妊娠相关血浆蛋白A与动脉粥样斑块的稳定性密切相关,对急性冠状动脉综合征诊断、预测以及危险分层可能具有重要价值。AIM： To explore the relevance between the circulating levels of pregnancy-associated plasma protein-A （PAPP-A） and acute coronary syndrome （ACS）. METHODS： The patients with acute myocardial infarction, unstable angina, and stable angina who were hospitalized at Chinese PLA General Hospital between October 2004 and February 2005 were adopted in this study, with 30 patients in each disease. And 30 healthy volunteers were chosen as controls from the Outpatient Department of the 305 Hospital of Chinese PLA during the same period. The levels of PAPP-A were detected by enzyme-linked immunoabsorbent assay （ELISA） method. Circulating levels of high-sensitivity C-reactive protein （hs-CRP） and concentrations of total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C） and triglyceride （TG） were measured in all subjects, and myocardial markers [（creatine kinase） CK, CK isoenzyme （CK-MB） and cardiac troponin （cTnT）] were tested in patients with acute myocardial infarction and unstable angina. The relationship between PAPP-A, hs-CRP and enzymology myocardial markers as well as between PAPP-A and the risk factors of coronary atheroselerotic heart disease were assayed by linear and multiple factors regression analysis with SPSS 12.0 software. RESULTS： Totally 120 patients were involved into the result analysis.（1） The circulating PAPP-A levels of patients with acute myocardial infaretion and unstable angina were markedly higher than those of patients with stable angina and controls [（6.23±7.38）, （5.74±7.45）, （1.23±0.70） and （0.87±0.57） mlU/L, P 〈 0.05]. And there were insignificant differences in the levels of PAPP-A between patients with acute myocardial infarction and unstable angina, and those of stable angina and controls （P 〉 0.05）.（2） Linear regression analysis showed that PAPP-A levels were correlated with hs-CRP levels in both acute myocardial infarction and unstable angina group （R^2=0.285, 0.779, P 〈 0.01）.（3）And m

关 键 词：妊娠相关血浆蛋白A 心肌梗塞 心绞痛 C反应蛋白 

分 类 号：R541.4[医药卫生—心血管疾病]