糖原磷酸化酶同工酶BB和肌钙蛋白I在急性冠脉综合征中的临床应用

Clinical application of glycogen phosphorylase-BB isoenzyme and .cardiac troponin I measurement in the diagnosis of acute coronary syndrome

目的探讨糖原磷酸化酶同工酶BB（GPBB）和肌钙蛋白I（cTnI）在急性冠脉综合征（ACS）早期诊断中的意义及对预后判断的价值。方法对125例急性心肌梗死（AMI）、120例不稳定型心绞痛（UAP）、29例稳定型心绞痛（SAP）患者和50例健康人分别进行血清GPBB和cTnI测定,并与肌红蛋白（Mb）、肌酸激酶同工酶（CK-MB）相比较,同时观察UAP组住院期间心脏事件发生的次数。结果健康人GPBB水平为（3.42±1.19）μg/L。在AMI发作后12h内,AMI患者血清中有119例GPBB浓度超过正常值上限（URL）6.99μg/L,诊断灵敏度为95.2%,稍高于cTnI的灵敏度93.6%,明显高于CK-MB、Mb（71.2%,43.2%）;不稳定型心绞痛（UAP）患者血清中GPBB水平明显高于健康对照组（P〈0.01）,cTnI差异有统计学意义（P〈0.05）,CK-MB、Mb则P〉0.05,伴有cTnI和GPBB升高的UAP患者住院期间心脏事件发生次数与健康对照组相比明显增加（P〈0.01）;稳定型心绞痛（SAP）组与健康对照组比较,GPBB、cTnI、CK-MB、Mb（P〉0.05）。结论GPBB是心肌损伤敏感、特异的指标,对急性心肌梗死的早期诊断、UAP患者预后判断有一定的临床价值。

Objective To investigate the clinical application of glycogen phosphorylase-BB isozyme （GPBB） and cardiac troponin I （cTnI） measurement in early diagnosis and prognosis evaluation of acute coronary syndrome （ACS）. Methods Serum levels of muscle hemoglobin （Mb） and creatin kinase isozyme （CK-MB） were measured in 125 patients with acute myocardial infarction （AMI）, 120 patients with unstable angina pectoris （UAP）,29 patients with stable angina pectoris （SAP） and 50 healthy people. The results were compared with that of Mb and CK-MB. The frequency of cardiac events oecurence was recorded. Results The GPBB concentration of healthy people is （3.42± 1.19） μg/L. GPBB in 119 AMI patients increased above the upper limit value （URL） 6.99μg/L within the first 12 h after AMI onset. The sensitivity of GPBB detected was 95.2%, just a little higher than cTnI （93.6%）, but obviously higher than CK-MB （71.2%） and Mb （43.2%）. GPBB and cTnI in UAP patients was significantly higher than that in healthy people（P%0.01 and P〈0.05） respectively, but there was no significant difference of CK-MB and Mb between the two groups （P〈0. 05）. The onset of cardiac events was more often in patients with high levels of cTnI or GPBB than that in patients with normal levels in UAP group （P〈0.01）. No significant difference was found in levels of GPBB, cTnI, CK-MB and Mb between SAP group and healthy control group （P〈0. 05）. Conclusion GPBB is a specific and sensitive index for myocardial damage, has an important clinical value in AMI early dignosis and prognosis evaluation of UAP.