髓过氧化物酶对急性冠状动脉综合征患者的早期临床筛查价值  

Early clinical screening value of myeloperoxidase in acute coronary syndrome

作　　者：马庆华[1] 邓爱云[2] 张钲[2] 刘兴荣[3] 潘明[2] 申希平[3] 白明[2] 王志禄[2] 

机构地区：[1]兰州大学第一医院医务科,甘肃兰州730000 [2]兰州大学第一医院心脏中心,甘肃兰州730000 [3]兰州大学公共卫生学院流行病与卫生统计学研究所,甘肃兰州730000

出　　处：《西安交通大学学报（医学版）》2012年第6期719-722,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的探讨髓过氧化物酶(MPO)对急性冠状动脉综合征(ACS)患者的早期临床筛查价值。方法将78例胸痛患者按ACC/AHA标准确诊ACS 41例、稳定性心绞痛(SAP)17例,其余20例为对照组。采用酶联免疫吸附法测定血浆MPO水平。结果 ACS组MPO水平明显高于对照组和SAP组(P<0.05);SAP组MPO水平高于对照组(P<0.05);MPO≥212.59μg/L组MPO、高敏感C反应蛋白(hs-CRP)、中性粒细胞(neutrophils)及ACS患者例数明显高于MPO<212.59μg/L组(P<0.05);MPO水平与neutrophils、肌酸激酶同工酶及ACS疾病严重程度呈正相关,与年龄、hs-CRP、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三脂、天冬氨酸氨基转移酶、空腹血糖、乳酸脱氢酶、红细胞计数、血小板计数无相关性;绘制ROC曲线(A=0.927,P<0.001),MPO诊断界值为212.59μg/L,MPO诊断ACS的灵敏度为95.1%,特异度为86.5%。本法与临床诊断ACS方法进行Kappa检验,P<0.001,Kappa系数值为0.819;采用Logistic逐步回归,MPO预测ACS总正确率为94.9%。结论 MPO是一种预测易损性斑块的炎症标志物,其能有效地早期筛查ACS患者。Objective To study the early predictive and clinical values of myeloperoxidase（MPO） in acute coronary syndrome（ACS）.Methods We enrolled 78 patients with chest pain,including 41 patients with ACS and 17 patients with stable angina pectoris（SAP）;the other 20 patients served as controls.The patients were diagnosed according to ACC/AHA guidelines.MPO was measured by enzyme-linked immunosorbent assay（ELISA）.Results The level of MPO increased significantly in the ACS patients compared with that in the SAP patients and controls（P0.05）;MPO was higher in the SAP patients than in the controls（P0.05）.MPO,high sensitive C-reactive protein（hs-CRP）,neutrophils and ACS cases were higher in patients with MPO≥212.59 μg/L than in patients with MPO212.59 μg/L（P0.05）.MPO had a positive correlation with neutrophils,creatine kinase isoenzyme,and ACS severity.MPO was not correlated with age,hs-CRP,white blood cell count,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,triglyceride,aspartate aminotransferase,fasting blood glucose,lactate dehydrogenase,red blood cell count,or platelet count.The best cut-off point for MPO was identified as ≥212.59 μg/L using the ROC curve（A=0.927,P0.001）,revealing elevated sensitivity（95.1%） and specificity（86.5%）.Using the Kappa measure,the two diagnostic methods were in good agreement（P0.001,Kappa value=0.819）.Logistic regression suggested a high predictive value of MPO in ACS with the total correct rate of 94.9%.Conclusion MPO,an inflammatory marker that can predict the vulnerable plaque,effectively screens ACS at an early stage.

关 键 词：髓过氧化物酶 急性冠状动脉综合征 炎症标志物 筛查 

分 类 号：R541.4[医药卫生—心血管疾病]