急性心肌梗死患者血清新蝶呤的变化及其预后判断价值

Serum neopterin levels in patients with acute myocardial infarction and its prognostic values

目的:探讨心肌梗死急性期血清新蝶呤(Neopterin,Npt)的变化及其预后判断价值。方法:以86例急性心肌梗死(AMI)患者为对象,与88例不稳定型心绞痛(UAP)、62例稳定型心绞痛(SAP)及35例健康者行对照观察。检测两组血Npt水平(AMI、UAP患者测定入院时、3d后和出院前3个时点,SAP与健康者为单次检测),记录AMI组住院及随访期间(11～13个月,平均11.2个月)心脏性死亡、再发性梗死、心绞痛等事件发生情况。结果:AMI组Npt阳性率及平均水平明显高于UAP、SAP及健康者(均P<0.01)。AMI患者入院时及3d后血Npt相似,均明显高于出院前(P<0.01)。血Npt阳性者,住院及随访期间心脏事件发生率显著高于Npt阴性者(P<0.05)。但有与无事件发生者,入院时、3d后、出院前3个时点血Npt水平比较,仅出院前差异有统计学意义(P<0.01)。经校正其他因素后,3个时点血Npt对AMI患者事件发生的相对危险度(95%可信区间)分别为4.7(0.6～36.3,P>0.05)、4.2(0.8～5.1,P>0.05)、7.2(1.8～29.6,P<0.01)。结论:AMI急性期血Npt明显升高,病情稳定后逐渐下降,此时的水平反映了不稳定斑块的炎症活动状况,是AMI患者预后的独立预测因子。

Objective:To determine the serum neopterin(Npt) levels in patients with acute myocardial infarction(AMI) and its prognostic values. Method:Eighty-six AMI patients, together with 88 patients with unstable angina(UA), 62 patients with stable angina(SA) and 35 healthy adults were studied. Their serum Npt levels were measured. For most AMI patients, the tests included three times of at admission, after 3 days and before discharge. Such events as cardiac death, recurrent AMI and angina during hospitalization and a follow-up lasting 11 to 13 months in the AMI group were recorded. Result:The serum Npt positive rate and average level in the AMI group were remarkably higher than those in the UA,SA and healthy group(P< 0.01). Npt levels at admission and after 3 days in AMI group were similar, and both significantly higher than that before discharge(P< 0.01). Events in the Npt positive subgroup were more frequent than those in the negative subgroup (P< 0.05). Nevertheless, among the differencs between the Npt levels at the three time point in patients with and without events, only the one before discharge was statistically significant(P< 0.01). After adjustment for other variables, the relative risk and 95% confidence interval for cardiac events according to elevated Npt levels at three time point were 4.7(0.6~36.3, P> 0.05), 4.2(0.8~5.1, P> 0.05) and 7.2(1.8~29.6, P< 0.01) respectively. No correlation was found between Npt and CKMB or cTnT. Conclusion: Serum Npt levels in AMI patients shortly after onset are markedly higher than those in UA,SA and healthy groups, which then reduce gradually with the remission of the condition. It is the Npt levels before discharge that reflects the inflammatory state of the vulnerable plaque and can be used to evaluate the outcome of the AMI patents.