冠状动脉介入术后妊娠相关蛋白A及C反应蛋白的变化及意义

Significance of plasma PAPP-A and CRP change after percutaneous coronary intervention

目的探讨冠状动脉介入术(PCI)前后血浆妊娠相关蛋白-A(PAPP-A)及C反应蛋白(CRP)水平[以高敏CRP(hs-CRP)衡量]的变化,以及其对术后6个月内心血管事件和再狭窄发生的预测价值。方法观察56例PCI患者(不稳定型心绞痛35例,稳定型心绞痛17例,心肌梗死4例)手术前及术后24h的PAPP-A、肌钙蛋白Ⅰ、肌酸激酶同工酶及CRP浓度,随访术后6个月内主要心血管事件(心肌梗死、再次血运重建及死亡)的发生情况,并于术后6个月复查冠状动脉造影,采用定量分析冠状动脉的狭窄,并计算后期内径丢失指数。分析手术前后PAPP-A和CRP水平与再狭窄及心血管事件的发生的关系。结果56例患者经PCI均成功,成功率100%;PCI后PAPP-A较术前高(P<0·05);且PCI前后的PAPP-A水平与CRP水平有较好的相关性(P<0·01),而与肌钙蛋白Ⅰ、肌酸激酶同工酶无相关性(P>0·05)。术后6个月内有心血管事件组患者PAPP-A及CRP水平较无心血管事件组高(P<0·01及P<0·05);PCI后6个月内有再狭窄的患者PAPP-A及CRP水平较无再狭窄的患者高((P<0·05及P<0·01),且PAPP-A及CRP与PCI后冠状动脉后期内径丢失指数呈正相关(r=0.70,P<0·01及r=0.71,P<0·01)。结论PCI后可导致体内PAPP-A与CRP合成增加,并在术后6个月内心血管事件及再狭窄的发生有重要作用。

Objective：To investigate the change and clinical value of PAPP-A and hs-CRP before and after percutaneous coronary intervention （PCI）. Method：The study involved 56 patients with ischaemic heart disease （35 with UAP,17 AP,4 with documented myocardicl infarction）who underwent elective PCI. Venous blood samples were drawn before and 24 h after operation. PAPP-A, TnI, CK-MB and hs-CRP concentrations were measured. The patients were scheduled for primary heart events and angiography six months after PCI. Late loss index was calculated using quantitative coronary angiography. Relationship among PAPP-A,hs-CRP concentrations and primary heart events or restenosis in two groups was analyzed. Result： PAPP-A and hs-CRP concentrations increased at 1 day after PCI. The change of PAPP-A concentrations was correlated with hs-CRP, but not with Tropin I and CK-MB. PAPP-A and hs-CRP concentrations at 24 h after PCI were higher in patients with late restenosis or primary heart events than in those without （P〈0. 01） cardiovascular events after PTCA. There was positive correlation between changes in PAPP-A and hs-CRP concentrations 1 day after PCI and late loss index six months after PCI. Conclusion： The production of PAPP-A and hs-CRP may play important role in late restenosis and primary heart events after PCI.