探讨血清心肌标志物与急性冠脉综合征患者危险分层的相关性  

Correlation of Risk Stratification of Acute Coronary Syndrome with Serum Myocardial Markers

作　　者：杨丽[1] 彭辉[1] 刘琴[1] 李晓征[1] 乔荔[1] 林雨薇[1] 马俊杰[1] 谢昆[1] 徐菲莉[1] 

机构地区：[1]新疆医科大学附属中医医院临床检验中心,乌鲁木齐830000

出　　处：《标记免疫分析与临床》2014年第2期127-131,共5页Labeled Immunoassays and Clinical Medicine

基　　金：国家高技术研究发展计划课题资助编号:2011AA02A111

摘　　要：目的探讨血清缺血修饰白蛋白(IMA)、心型脂肪酸结合蛋白(H-FABP)及尿酸(UA)与急性冠脉综合征(ACS)危险分层的关联性。方法将71例患者根据ACS诊断标准分为UAP组、NSTEMI组和STEMI组;根据GRACE标准对患者进行危险评分并计算院内以及出院6个月时死亡以及死亡/心梗风险;按GRACE评分标准将各组患者分为低危、中危、高危三组;对不同分组及不同危险分层进行比较。结果 71例ACS患者,UAP22例(31%),其中低危组10例,中危组9例,高危组3例;NSTEMI 17例(24%),其中低危组3例,中危组7例,高危组7例;STEMI 32例(45%),其中低危组4例,中危组18例,高危组10例。根据危险分层,UAP与NSTEMI各组间的院内死亡危险积分和院内死亡率的差异有统计学意义(P<0.05);STEMI组的院内死亡率在低高危组、中高危组间差异有统计学意义(P<0.01),但低中危组间差异无统计学意义(P>0.05);院内死亡危险积分在不同分层间差异有统计学意义(P<0.01);H-FABP和UA在三组各自的分层间差异无统计学意义(P>0.05);而IMA在NSTMEI组危险分层的低高危、中高危组间差异有统计学意义(P<0.01),在其余两组的各自分层间差异无统计学意义(P>0.05);UAP、NSTEMI和STEMI的低危组、中危组和高危组比较,院内死亡率、H-FABP、IMA、UA均无统计学意义(P>0.05);而UAP、NSTEMI和STEMI的高危组比较,院内死亡危险积分在UAP与STEMI组间差异有统计学意义(P<0.05)。结论院内死亡率、院内死亡危险积分是进行危险分层的有效指标,根据危险分层可初步判断患者病情,指导临床治疗。但H-FABP、IMA、UA的检查结果尚不能作为判断病情的指标来指导临床。Objective To explore the correlation of risk stratification of acute coronary syndrome （ACS）with ischemia modified albumin （IMA）,heart fatty acid binding protein （H-FABP） and uric acid.Methods 70patients were divided into unstable angina pectoris （UAP）,ST-elevation myocardial infarction （STEMI） and non ST-elevation myocardial infarction （NSTEMI） group based on ACS standard.They were divided into low-risk,intermediate-risk and high-risk groups based on GRACE risk score.Results 22 （31％） patients were admitted for UAP,17 （24％） for NSTEMI,and 32 （45％） for STEMI.There were significantly difference in hospital mortality risk score and hospital mortality between UAP and NSTMEI groups （P ＜ 0.05）.The hospital mortality in STEMI group had significantly difference between low and high-risk group （P ＜ 0.05）.There were no significantly difference for serum H-FABP and UA levels in three groups （P ＞ 0.05）.The serum IMA had clearly difference between low and high-risk group in NSTMEI （P ＜0.01）.Conclusion Hospital mortality risk score and hospital mortality play an important role in GRACE to indicate the disease severity.The serum H-FABP,IMA and UA levels cannot be considered as the indexes to judge the degree of ACS.

关 键 词：危险分层 急性冠脉综合征 缺血修饰白蛋白 心型脂肪酸结合蛋白 尿酸 

分 类 号：R541.4[医药卫生—心血管疾病]