超敏C反应蛋白检测在急性冠状动脉综合征诊断中的意义

Significance of determination of high sensitive C-reactive protein in diagnosis of acute coronary atery syndrome

目的探讨超敏C反应蛋白(hs-CRP)检测在急性冠状动脉综合征(ACS)发生、发展及预后诊断中的意义。方法随机选取冠状动脉造影证实为ACS的患者104例,其中急性心肌梗死(AMI)32例,不稳定型心绞痛(UA)41例,稳定型心绞痛(SA)31例,35例健康对照者。采用散射免疫比浊法测定其血清中hs-CRP浓度,并结合心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-Mb)和同工酶(Mb)进行分析。结果hs-CRP与cTnI、CK-Mb和Mb相似,由SA、UA至AMI,它们的水平都依次增高且各组差异有统计学意义(P<0.01或P<0.05);在诊断AMI患者时阳性率分别为91.0%、97.0%、81.0%、67.0%,同时,随着冠状动脉病变的变化,由单支病变、双支病变至三支病变,hs-CRP的水平也依次增高,差异有统计学意义(P<0.01);hs-CRP与cTnI在预测UA患者发生心脏事件的敏感性分别为75.0%,91.3%、特异性为78.9%,89.2%。结论血清hs-CRP水平与ACS发生、发展及预后密切相关。

Objeetive To investigate the diagnostic value of determining high sensitive C reactive protein （hs- CRP） in acute coronary artery syndrome （ACS） and to explore its clinical significance. Methods 94 ACS patients confirmed by coronary angiography were randomly recruited, including 32 cases of acute myocardial infarction （AMI） ,41 cases of unstable angina pectoris（UAP） and 31 cases of stable angina pectoris（SAP）. Another 35 healthy persons were recruited as control group. Their levels of serum hs-CRP were determind by transmission immunity nephelometery, and serum cardiac specific troponin I（TnI）, creatine kinase isoenzyme Mb（CK-Mb）, and myohemoglobin（Mb） were analysed respectively. Results Similar to cTnI, CK-Mb and Mb, the plasma hs-CRP levels increased sequentially in the normal control group, the stable angina pectoris group,the unstable angina ectoris group and acute myocardial infaction, hs-CRP concentration of ACS patients was significantly higher than that of the control group（P〈0.01or P〈0.05）. The levels of hs-CRP of AMI group were significantly higher than those in UAP group（P〈0.01） ,the levels of hs-CRP of UAP group were significantly higher than those in SAP group（P〈0.01）. Meanwhile,positive rate of hs-CRP, cTnI,CK-Mb and Mb in the diagnosis of AMI was 91 %, 97 %, 81% and 67 respectively. The hs-CRP level of one vessel lesion group, 2 vessels group and 3 vessels lession group were increased sequentially, and were significantly higher than that in normal control group（P〈0.01）. In predicting cardiac events during observation, the sensitivity and sepecificity of hs-CRP were 75.0 %, 78.9 % respectively and that of cTnI were 91.3% ,89.2%. Conelasion The level of serium hs-CRP in ACS increases significantly, hs-CRP is of great value to the diagnosis, treatment and prognosis of ACS.