皮离蛋白多肽在急性冠脉综合征早期诊断及鉴别诊断中的价值探讨  

The significance of a 4 183 Da peptide of dermcidin protein in the early diagnosis and differential diagnosis of acute coronary syndrome

作　　者：冯凯[1] 刘利峰[2] 宋海晶[3] 刘先华[3] 夏鹄[3] 

机构地区：[1]解放军第306医院特种医学实验研究中心,北京100101 [2]解放军第306医院心内科,北京100101 [3]解放军第306医院急诊科,北京100101

出　　处：《中华危重病急救医学》2015年第12期970-974,共5页Chinese Critical Care Medicine

摘　　要：目的探讨皮离蛋白（dermcidin）4183Da多肽片段是否具有早期诊断和鉴别诊断缺血性心脏病的预警价值。方法采用前瞻性对照研究方法，选择解放军第306医院收治的161例急性冠脉综合征（ACS）患者[其中不稳定型心绞痛（uA）46例，急性非sT段抬高型心肌梗死23例，急性sT段抬高型心肌梗死92例]，以111例常规体检者（其中有高血压病史45例，冠心病病史42例，糖尿病病史22例）和54例非ACS疾病患者（包括肺栓塞、主动脉夹层、心律失常、心肌炎、冠状动脉肌桥、胸膜炎、气胸、纵膈气肿、肋骨骨折、反流性食管炎、消化性溃疡、胰腺炎等）作为对照。采用基质辅助激光解析离子化飞行时间质谱（MALDI—TOF—MS）技术测定皮离蛋白4183Da多肽水平，并与髓过氧化物酶[MPO，分别采用床旁快速检测法（POCT）和酶联免疫吸附试验（ELISA）检测]、超敏C-反应蛋白（hs—CRP）、心脏型脂肪酸结合蛋白（H—FABP）、肌红蛋白（MYO）、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK—MB）等多种标志物诊断和鉴别诊断缺血性心脏病的特异性及敏感性进行对比分析。结果①单因素方差分析显示，4183Da多肽水平在ACS患者中高于体检对照组（相对丰度：22．05±16．97比15．52±14．09，P=0．001），但ACS组与非ACS组之间水平相当（相对丰度：22．05±16．97与19．99±17．63，P=0．416）。②利用受试者工作特征曲线（ROC）分析4183Da多肽和MPO早期预警ACS、UA的特异性及敏感性，结果显示4183Da多肽对ACS和UA都具有一定的预警意义，ROC曲线下面积（AUC）分别为0．625和0．651（均P〈0．01），明显优于ELISA检测MPO对二者的诊断价值（AUC分别为0．440和0．336，均P〉0．05）。⑧比较4183Da多肽和多种标志物在急性心肌梗死（AMI）、UA与非ACS疾病鉴别诊断中的价值，结果显示4183Da多肽鉴别诊断AMI与非ACS疾病�Objective To investigate the predictive value of 4 183 Da peptide of dermcidin protein in the early diagnosis and differential diagnosis of ischemic heart disease. Methods A prospective controlled study was conducted. Serum samples were drawn from 161 patients with acute coronary syndrome [ACS, including 46 patients with unstable angina （UA）, 23 with acute non-ST elevation myocardial infarction, and 92 with acute ST segment elevation myocardial infarction ], 111 subjects for routine physical examination, including 45 patients with hypertension history, 42 with coronary heart disease, 22 with diabetes, and 54 patients with non-ACS （including pulmonary embolism, aortic dissection aneurysm, arrhythmia, myocarditis, coronary myocardial bridge, pleurisy, pneumothorax, pneumomediastinum, rib fracture, reflux esophagitis, peptic ulcer, and pancreatitis ） to serve as controls. 4 183 Da peptide of dermcidin protein was assessed with matrix assisted laser desorption ionization time-of-flight mass spectrometry （MALDI-TOF-MS） technology, and myeloperoxidase [ MPO, determined by point-of-care testing （POCT） and enzyme linked immunosorbent assay （ELISA）, respectively ], high sensitive C-reactive protein （hs-CRP）, heart type fatty acid binding protein （H-FABP）, myoglobin （MYO）, cardiac troponin I （cTnI）, and MB isoenzyme ofcreatine kinase （ CK-MB ） were quantitated with biochemical analysis. The power of the biomarkers above for early diagnosis and differential diagnosis for ischemic heart disease were judged by comparison of their sensitivity and specificity. Results ① It was showed by one-way ANOVA that 4 183 Da peptide was higher in ACS group than that in control group （relative abundance： 22.05 ± 16.97 vs. 15.52± 14.09, P = 0.001 ）, but no difference was found between ACS group and non-ACS group （relative abundance： 22.05± 16.97 vs. 19.99± 17.63, P = 0.416）. ② The specificity and sensitivity of the 4 183 Da polypeptide and MPO for predicting ACS and UA were compare

关 键 词：急性冠脉综合征 不稳定型心绞痛 诊断标志物 皮离蛋白(dermcidin) 鉴别诊断 

分 类 号：R541.4[医药卫生—心血管疾病]