血清AST、m-AST水平和m-AST/AST比值在CHD患者及AMI患者术前、术后评估中的价值  

Roles of AST,m-AST and m-AST/AST in preoperative and postoperative evaluation of patients with CHD and AMI

作　　者：张茜林 沈逸枫 朱晶 张春燕 邵文琦 王蓓丽 郭玮 ZHANG Xilin;SHEN Yifeng;ZHU Jing;ZHANG Chunyan;SHAO Wenqi;WANG Beili;GUO Wei(Department of Clinical Laboratory,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Clinical Laboratory,Zhongshan Hospital,Fudan University(Xiamen Branch),Xiamen 361015,Fujian,China)

机构地区：[1]复旦大学附属中山医院检验科,上海200032 [2]复旦大学附属中山医院厦门医院检验科,福建厦门361015

出　　处：《检验医学》2021年第5期471-476,共6页Laboratory Medicine

基　　金：国家自然科学基金面上项目(81772263);国家自然科学基金面上项目(81972000);国家自然科学基金青年项目(81902139);2019厦门市医疗卫生重点项目(YDZX20193502000002);2017年“上海青年临床医技人才(临床检验专业)培养资助计划”;复旦大学附属中山医院院内临床研究项目(2018ZSLC05);上海市临床重点专科建设项目(医学检验科)。

摘　　要：目的对免疫抑制法测定线粒体天门冬氨酸氨基转移酶(m-AST)的检测性能进行评价。探讨冠心病(CHD)患者和急性心肌梗死(AMI)患者血清天门冬氨酸氨基转移酶(AST)、m-AST、m-AST/AST比值的变化。方法对免疫抑制法测定m-AST的检测性能(精密度、正确度、线性范围、参考区间、最大稀释比)进行评估。选取行药物洗脱支架置入术的CHD患者和急诊行经皮冠状动脉介入治疗(PCI)术的AMI患者各44例,分别测定其术前、术后血清AST、m-AST等指标,计算m-AST/AST比值,并分析各项指标与Gensini积分的相关性。结果免疫抑制法检测m-AST的精密度、正确度、线性范围、参考区间均通过验证,符合临床要求,最大稀释比为1∶10。CHD患者PCI术后AST、m-AST水平及m-AST/AST比值与术前比较,差异均无统计学意义(P>0.05)。AMI患者PCI术后AST、m-AST、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶MB质量(CK-MB mass)、氨基末端B型钠尿肽原(NT-proBNP)水平显著高于术前(P<0.05),m-AST/AST比值显著低于术前(P<0.05)。CHD患者和AMI患者不同Gensini积分各组之间术后AST、m-AST水平及m-AST/AST比值与术前比较,差异均无统计学意义(P>0.05);且术前、术后AST、m-AST、m-AST/AST比值与Gensini积分均无相关性(P>0.05)。AMI患者术前、术后AST、m-AST水平和m-AST/AST比值均显著高于CHD患者(P<0.05),术前m-AST/AST比值差异无统计学意义(P>0.05)。结论血清AST、m-AST水平和m-AST/AST比值的变化与心肌细胞损伤程度有关,与动脉粥样硬化斑块发展进程无关,可反映AMI患者的心肌损伤情况及恢复情况。Objective To evaluate the performance of immunosuppressive assay for mitochondrial aspartate aminotransferase(m-AST),and to investigate the changes of serum aspartate aminotransferase(AST),m-AST and m-AST/AST in patients with coronary heart disease(CHD)and acute myocardial infarction(AMI).Methods The determination performance(precision,accuracy,linear range,reference interval,maximum dilution ratio)of immunosuppressive assay for m-AST was evaluated.Totally,44 patients with CHD undergoing drug-eluting stent implantation and 44 emergency patients with AMI undergoing percutaneous coronary intervention(PCI)were enrolled.Preoperative and postoperative AST and m-AST levels were determined,the ratio of m-AST/AST was calculated,and their correlations with Gensini score were analyzed.Results The precision,accuracy,linear range and reference interval of immunosuppressive assay for m-AST were all verified,which met the clinical requirements,and the maximum dilution ratio was 1∶10.There was no statistical significance in the levels of AST,m-AST and m-AST/AST between CHD patients before and after PCI(P>0.05).The levels of AST,m-AST,cardiac troponin T(cTnT),creatine kinase MB isoenzyme mass(CK-MB mass)and N-terminal B-type natriuretic peptide(NT-proBNP)in AMI patients after PCI were higher than those before PCI(P<0.05),and the m-AST/AST was lower than that before PCI(P<0.05).There was no statistical significance in the levels of AST,m-AST and m-AST/AST between CHD patients and AMI patients with different Gensini scores before and after operation(P>0.05),and there was no correlation between AST,m-AST,m-AST/AST and Gensini score before and after operation(P>0.05).The levels of AST and m-AST before operation,as well as AST,m-AST and m-AST/AST after operation in AMI patients were higher than those in CHD patients(P<0.05),but there was no statistical significance in m-AST/AST before operation(P>0.05).Conclusions The changes of serum AST,m-AST and m-AST/AST are related to the degree of myocardial cell injury,but not to the develop

关 键 词：线粒体天门冬氨酸氨基转移酶 冠心病 急性心肌梗死 经皮冠状动脉介入治疗术 GENSINI积分 

分 类 号：R446.1[医药卫生—诊断学]