急性冠脉综合征患者髓过氧化物酶变化特征的研究  

Changes of myeloperoxidase in patients with acute coronary syndrome

作　　者：邢雁伟[1] 王阶[1] 马长生[2] 李十红[2] 李志忠[2] 高永红[3] 农一兵[4] 张维民[5] 

机构地区：[1]中国中医科学院广安门医院心血管科,北京市100053 [2]首都医科大学安贞医院,北京市100029 [3]北京中医药大学东直门医院,北京市100700 [4]东方医院 [5]济南中心医院,济南市250013

出　　处：《中华老年多器官疾病杂志》2008年第3期166-170,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家重点基础研究项目(973项目;No.2003CB517103)

摘　　要：目的研究髓过氧化物酶(MPO)对急性冠脉综合征的预测和临床预后。方法618例经冠脉造影术后患者分为冠状动脉造影正常组、稳定性心绞痛组和急性冠脉综合征组,于入院当天抽血测MPO含量。随访6个月,分别在第1、3、6个月记录终点事件的发生率。结果(1)急性冠脉综合征血清中MPO含量显著高于正常组和稳定性心绞痛组。(2)在急性冠脉综合征的预测中,当肌钙蛋白Ⅰ<0.05μg/L,MPO对急性冠脉综合症的预测显著高于肌钙蛋白I和C反应蛋白。(3)卡卜兰-迈尔图显示,MPO水平≥62.9AUU/L组的6个月随访终点事件的累计发生率显著高于MPO水平<62.9AUU/L。结论MPO对急性冠脉综合征的预测及危险分层是一个新颖的指标,在临床上有一定的意义,尤其是在没有急性心肌缺血和坏死的情况下。Objective To study the significance of myeloperoxidase（MPO） for predction and prognosis of acute coronary syndrome（ACS）. Methods The study subjects consisted of 618 consecutive patients. They were divided into normal, stable angina pectoris （SAP）, unstable angina pectoris（UAP）/non-ST elevation myocardial infarct（NSTEMI） and ST elevation myocardial infarct （STEMI） groups. The blood serum of every patient was collected in 24h after admission. MPO, C reactive protein （CRP） and troponin I （TNI） of blood serum were measured and compared among the 4 groups. Through receiver operating characteristic （ROC） curve analysis, ACS was predicted by MPO, TNI and CRP. The patients were followed up for 6 months, and follow-up examinations were performed at 1, 3, and 6 months respectively. The end points included death, MI, revascularization and coronary artery bypass. Results （1） MPO levels in ACS group were significantly higher than that in normal and SAP groups. （2）ROC curve for the prediction of ACS were plotted for the entire cohort and for the cohort of patients who were consistently negative for TNI. In the cohort consistently negative for TNI （TNI ≤ 0.05 μg/L, n=446）, the area under the curve for MPO （area=0. 680, P=0.02） was significantly larger than that forTNI （area=0.629, P=0. 09） and CRP （area=0.489, P=0. 31）, which showed that MPO level was higher than TNI and CRP levels and thus higher value for predicting ACS. （3） Kaplan-meier estimator curves showed that according to serum MPO （median 62. 9AUU/L; n= 618） , the cumulative incidence of end point events during 6-month follow-up in MPO 〉 62. 9 AUU/L group was significantly higher than that in MPO≤ 62. 9 AUU/L group. Conclusion MPO may be a new predictor for adverse outcome in patients with ACS, particularly in individuals with low TNI levels.

关 键 词：过氧化物酶 肌钙蛋白I C反应蛋白 冠状动脉疾病 

分 类 号：R541.4[医药卫生—心血管疾病] R743.31[医药卫生—内科学]