妊娠相关性血浆蛋白-A在急性冠状动脉综合征诊断及远期预后中的作用

Effect of pregnancy-associated plasma protein -A on diagnosis and long-term outcomes of acute coronary syndrome patients.

目的 探讨妊娠相关性血浆蛋白-A（PAPP—A）在急性冠状动脉综合征（ACS）诊断及远期预后中的预测作用。方法 ACS患者100例分为不稳定型心绞痛（UAP）组64例和急性心肌梗死（AMI）组36例，正常对照组50例。分别检测其血清PAPP-A、高敏C-反应蛋白（hs—CRP）、磷酸肌酸激酶同工酶（CK-MB）和肌钙蛋白（cTnI）浓度。对CK-MB和cTnI均在正常范围的UAP组患者随访心血管终点事件6个月。结果 与正常对照组比较，ACS患者的血清PAPP-A、hs—CRP、CK-MB、cTnI水平均明显增高（P均〈0．01），但PAPP-A水平与CK—MB、cTnI无明显相关性。CK-MB和cTnI均在正常范围的UAP患者随访6个月，发现血清PAPP—A水平与心血管终点事件发生率呈明显正相关（P〈0．01）。结论 ACS患者的血清PAPP-A浓度与心肌缺血、坏死程度无关，但可作为动脉粥样斑块的不稳定判断指标，用于ACS患者的预后判断。

Objective To investigate the value of Pregnancy-associated plasma protein-A （PAPP-A） in the diagnosis and outcomes of acute coronary syndrome （ACS ） patients. Methods 100 ACS patients were divided into unstable angina pectoris （ UAP ） group （ n = 64 ）, acute myocardial infarct （ AMI ） group （ n = 36 ） and 50 healthy cases as control group. The levels of PAPP-A, high sensitive C-reactive protein （ hs-CRP ）, CK-MB and troponin （ cTnI ） were detected. The ACS patients with normal CK-MB and cTnI concentration were followed up for 6 months so that the total rates of major cardiovascular events （ MACE ） were recorded. Results Comparing to control group, the PAPP-A,hs-CRP,CK-MB,and cTnI levels of ACS patients were significantly increased （ P 〈 0.01 ）, but the levels of PAPP-A was not associated with CK-MB and cTnI. The ACS patients with normal CK-MB and cTnI concentration were followed up for 6 months, showing that the levels of PAPP-A were positively associated with the MACE （ P 〈 0. 01 ）. Conclusion The levels of PAPP-A of ACS patients are not associated with myocardial ischemic necrosis, but may be served as a predictor of unstable atherosclerotic plaque and a valuable index for judging prognosis.