急性冠状动脉综合征与不稳定斑块的检测

Acute Coronary Syndrome and Detection of Unstable Plaque

目的研究高敏C反应蛋白(hs-CRP)、血浆妊娠相关蛋白A(PAPP-A)、基质金属蛋白酶-9(MMP-9)在急性冠状动脉综合征(ACS)的诊断及评价短期预后中的价值。方法选取ACS患者60例(分为不稳定心绞痛组(UA)35例和急性心肌梗死组(AM I)25例及健康对照组30例,检测血清hs-CRP及PAPP-A、MMP-9的水平,并对ACS患者进行30 d的随访。结果对照组、不稳定心绞痛(UA)组、急性心肌梗死(AM I)组间hs-CRP、PAPP-A和MMP-9差异有统计学意义(P<0.01),其中hs-CRP任意2组间差异均有统计学意义(P<0.01;P<0.05);PAPP-A和MMP-9任意2组间差异均有统计学意义(P<0.01)。患者血清hs-CRP与PAPP-A、MMP-9水平有相关性。单变量分析显示随访30 d内发生主要不良心血管事件(MACE)的患者hs-CRP及PAPP-A、MMP-9水平高于未发生者(P<0.01),Logistic回归显示PAPP-A、MMP-9与ACS短期预后显著相关(P<0.05)。结论hs-CRP及PAPP-A、MMP-9的水平可以反映斑块的不稳定性,是ACS的重要危险因素。炎症加重了斑块的不稳定性,从而参与了ACS的发生发展。PAPP-A、MMP-9可以作为ACS患者短期预后的独立危险因素。对于ACS的短期预后的评估,PAPP-A和MMP-9较hs-CRP有更大的应用前景。

Objective The aim of the present study is to assess the value of hs-CRP,PAPP-A and MMP-9 in diagnosis and to evaluate the short-term prognosis of ACS.Methods Sixty patients with ACS and 30 patients without ACS were enrolled in this study.The hs-CRP PAPP-A MMP-9 levels were measured.Patients with ACS were followed up for 30 days after admission.The relation between these three factors and the 30 days prognosis were observed.Results Blood hs-CRP levels showed significant differences between control and unstable angina(UA) groups(P<0.05),control and acute myocardial infarction(AMI) groups)P<0.01),as well as UA and AMI groups(P<0.01).There were very significant differences in blood PAPP-A and MMP-9 levels(P<0.01).Blood hs-CRP was positively correlated with blood PAPP-A and MMP-9.Single factor analysis showed all the three levels were higher in MACE patients(P<0.01).Logistic regression analysis showed that blood PAPP-A and MMP-9 were correlated with MACE in 30 days(P<0.05).Conclusion Because the hs-CRP,PAPP-A and MMP-9 might decrease the stability of the plaque,they are important risk factors of ACS.Inflammation affected the development and changes of ACS by decreasing the stability of the plaque.The levels of hs-CRP PAPP-A and MMP-9 are correlated with the short-term prognosis of ACS.PAPP-A and MMP-9 levels are independent risk factors of short-term prognosis in ACS patients.PAPP-A and MMP-9 could be better predictors than hs-CRP.