急性冠状动脉综合征患者外周循环中性粒细胞髓过氧化物酶测定的临床意义  

Clinical significance of neutrophil myeloperoxidase on peripheral circulation in acute coronary syndrome

作　　者：王媛媛[1] 黎莉[1] 周风华[1] 孟晓[1] 钟明[1] 张薇[1] 张运[1] 

机构地区：[1]教育部和卫生部心血管重构和功能研究重点实验室山东大学齐鲁医院心内科,济南250012

出　　处：《山东大学学报（医学版）》2007年第10期996-999,1003,共5页Journal of Shandong University:Health Sciences

基　　金：卫生部临床学科重点项目资助课题(20044681);山东省自然科学基金资助课题(Y2005C32);山东省科技攻关项目(2005GG4402020)

摘　　要：目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者外周循环血中性粒细胞髓过氧化物酶(myeloperoxidase,MPO)浓度的改变及其预测易损斑块的价值。方法91例行冠状动脉造影患者分为4组,急性心肌梗塞(AMI)组19例、不稳定心绞痛(UAP)组30例、稳定心绞痛(SAP)组22例和对照组20例,抽取股静脉血分别应用流式细胞技术检测MPO浓度和粒子增强散射比浊法测定高敏C反应蛋白(high-sen-sitivity C-reactive protein,hsCRP)水平;采用透射电镜观察中性粒细胞超微结构的变化。结果UAP组股静脉血MPO门内百分数显著高于AMI组、SAP组和对照组(P均<0.05),AMI组股静脉血MPO平均荧光强度显著低于UAP组、SAP组和对照组(P均<0.05);UAP组和AMI组与对照组和SAP组相比,股静脉血hsCRP显著增高(P均<0.05),而UAP组和AMI组、SAP组与对照组之间差异无统计学意义;UAP组MPO门内百分数和hsCRP在不稳定斑块明显高于稳定斑块(P均<0.05)。电镜下观察对照组中性粒细胞形态较为规则,胞浆内含有大小、形状不一的不同电子密度颗粒,呈圆形或椭圆形,空泡较少;AMI患者中性粒细胞颗粒明显减少,空泡显著增多;UAP患者则显示中性粒细胞颗粒丰富,空泡少见。结论外周循环血中MPO的含量不仅能提示ACS易损斑块的存在,而且能反映病变的严重程度。Objective To study the changes of peripheral venous blood concentration of myeloperoxidase （MPO） in patients with acute myocardial infaretion（AMI）, unstable angina pectoris（UAP） and stable angina pectoris（SAP）. Methods For 91 patients subjected to coronary angiography, including 19 patients in the AMI group, 30 in the UAP group, 22 in the SAP group and 20 in the control group, the concentrations of MPO and high-sensitivity C-reactive protein （hsCRP） in the femoral vein were determined. The ultra-structure of leukocytes was observed by transmission electron mirror. Results The in-gate percentage of MPO in the femoral vein was higher in the UAP group than in the AMI, the SAP and the control groups （ P 〈 0.05, respectively）, and there were no differences between the later three groups. The average fluoescent intensity of MPO in the femoral vein was more weakened in the AMI group than in the UAP, the SAP and the control groups （ P 〈 0.05, respectively）, and there were no differences between the later three groups. Compared with the control group, concentrations of hsCRP in the UAP and the AMI groups were significantly increased, but no difference existed between the UAP and the AMI groups or between the SAP and the control groups. In the UAP group, patients with type Ⅱ lesions showed a higher in-gate percentage of MPO （ P 〈 0.05） and a higher concentration of hsCRP （P 〈 0.05） than those with type Ⅰ lesion. Through an electron mirror, few vacuoles were found in the cytoplasm of the neutrophil in the control group, less particles and more vacuoles in the AMI group, and abundant particles and very few vacuoles in the UAP group. Conclusion Different changes of MPO between patients with AMI and UAP can not only predict ACS but also reflect the severity of inflammation.

关 键 词：中性粒细胞 髓过氧化物酶 急性冠脉综合征 高敏C反应蛋白 

分 类 号：R541.4[医药卫生—心血管疾病]