髓过氧化物酶对胸痛患者的临床意义  

Clinical significance of myeloperoxidase in patients with chest pain

作　　者：马庆华[1] 邓爱云[1] 张钲[1] 刘兴荣[2] 潘明[1] 申希平[1] 白明[1] 王志禄[1] 

机构地区：[1]兰州大学第一医院,甘肃兰州730000 [2]兰州大学公共卫生学院,甘肃兰州730000

出　　处：《检验医学》2013年第1期25-29,共5页Laboratory Medicine

摘　　要：目的探讨髓过氧化物酶(MPO)浓度与急性冠状动脉综合征(ACS)发生、发展的关系及胸痛患者检测血浆MPO的临床意义。方法将78例胸痛患者按美国心脏病学会(ACC)/美国心脏协会(AHA)标准确诊为ACS 41例、稳定性心绞痛(SAP)17例,其余20例列为对照组。采用酶联免疫吸附法测定血浆MPO浓度,同时检测血白细胞(WBC)、中性粒细胞(Neu)、红细胞(RBC)、血小板(PLT)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)、空腹血糖(FBG)、乳酸脱氢酶(LDH)及高敏C反应蛋白(hs-CRP)。分析MPO与其他指标的相关性;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析MPO对ACS的诊断性能,并与临床诊断ACS的方法(临床表现加冠状动脉造影)做对比(Kappa一致性检验)。结果 ACS组血浆MPO浓度明显高于对照组和SAP组(P<0.05),且SAP组高于对照组(P<0.05)。血浆MPO浓度与Neu、CK-MB及疾病严重程度呈正相关(r值分别为0.288、0.469、0.757,P值分别为0.018、0.043、0.000),与年龄、hs-CRP、TC、LDL-C、HDL-C、TG、AST、FBG、LDH、RBC、PLT均无相关性(P>0.05)。MPO诊断ACS的AUC为0.927(P=0.000),诊断界值为212.59μg/L。41例ACS患者中MPO阳性39例、阴性2例;37例非ACS患者(包括SAP 17例、对照者20例)中MPO阳性5例、阴性32例。MPO诊断ACS的敏感性为95.1%、特异性为86.5%、总符合率为91.0%、假阴性率(漏诊率)为4.9%、假阳性率(误诊率)为13.5%、阳性预测值为88.6%、阴性预测值为94.1%。本法与临床诊断ACS方法的Kappa值为0.819(P=0.000),2种方法的一致性较好。结论 MPO可以作为诊断ACS的炎症标志物之一,对于ACS的鉴别具有重要的临床意义。Objective To investigate the relationship between myeloperoxidase （MPO） concentration and the onset and progression of acute coronary syndrome （ACS） and the clinical significance of MPO in patients with chest pain. Methods A total of 78 patients with chest pain were enrolled and classified into 41 patients with ACS, 17 patients with stable angina peetoris （SAP） and 20 controls according to the guideline of American College of Cardiology （ACC）/ American Heart Association （AHA）. MPO concentration was measured by enzyme-linked immunosorbent assay. White blood cell （WBC）, neutrophil（Neu）, red blood cell （RBC）, platelet （PLT）, total cholesterol （TC）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDL-C）, triglyceride （TG）, creatine kinase MB isoenzyme （ CK-MB）, aspartate aminotransferase （ AST）, fasting blood glucose （ FBG）, lactate dehydrogenase （LDH） and high sensitive C reactive protein （hs-CRP） were detected. The correlations between MPO and other parameters were analyzed. By the receiver operating characteristic （ROC） curve, the area under ROC curve （AUC） was calculated. The diagnostic performance of MPO for ACS was evaluated. This technology was compared with the diagnostic methods of clinical manifestation analysis and coronary angiography based on the measurement of Kappa concordance. Results The plasma MPO concentration in patients with ACS was significantly higher than those in patients with SAP and controls （ P 〈 0.05 ）, and the MPO concentration in patients with SAP was higher than that in controls （P 〈 0.05）. The positive correlation was observed between MPO concentration and Neu, CK-MB and the severity of disease （ r = 0. 288, 0. 469 and 0.757, P =0. 018, 0. 043 and 0. 000）. MPO concentration did not correlate with age, hs-CRP, TC, LDL-C, HDL-C,TG, AST, FBG, LDH, RBC and PLT （P 〉0.05）. The cut-off value for MPO was identified as 212.59 μg/L （AUC = 0. 927, P = 0. 000

关 键 词：髓过氧化物酶 急性冠状动脉综合征 胸痛 炎症标志物 

分 类 号：R541.4[医药卫生—心血管疾病]