妊娠相关血浆蛋白A预测急性冠脉综合征的价值

Clinical significance of pregnancy-associated plasma protein-A in acute coronary syndrome

目的探讨妊娠相关血浆蛋白A(PAPP-A)在急性冠脉综合征(ACS)早期诊断中的价值。方法以82例临床诊断为ACS的患者为研究对象,其中急性心肌梗死(AMI)56例,不稳定型心绞痛(UAP)26例。另取20例稳定型心绞痛(SAP)和20例健康者为对照。测定血清PAPP-A、C反应蛋白(CRP)及ACS患者血清肌酸激酶同工酶(CK-MB)、肌钙蛋白T(TNT)水平。采用单因素方差分析方法比较各组间临床资料;应用秩和检验方法比较各组间PAPP-A和CRP水平;应用Spearman等级相关方法说明PAPP-A与CRP、CK-MB、TNT的相关程度,并计算ROC曲线下面积比较PAPP-A和CRP水平对ACS的早期诊断价值。结果ACS患者PAPP-A和CRP水平明显高于SAP组和对照组(P<0·01,P<0·001),UAP与AMI之间、SAP与对照组之间比较差异均无统计学意义(P>0·05)。ACS患者PAPP-A与CRP明显相关(r=0·898,P<0·01),与CK-MB及TNT无相关性。应用PAPP-A早期预测ACS患者的ROC曲线下面积为0·91,应用CRP早期预测ACS患者的ROC曲线下面积为0·78,PAPP-A相应的敏感性为88%,特异性为84%。结论PAPP-A可以反映冠状动脉粥样硬化斑块的不稳定性,对ACS有早期诊断价值,但不是心肌坏死的标志物。

Objective To evaluate the value of pregnancy - associated plasma protein - A （ PAPP - A ） in the diagnosis of acute coronary syndrome （ ACS ）. Methods To measure PAPP - A, C reactive protein in 56 patients with AMI, 26 patients with UAP, 20 patients with SAP and 20 controls. In the different groups, clinical data were compared with one - way ANOVA, PAPP - A and CRP were evaluated by Kruskal - Wallis test, correlation between PAPP - A and CRP, CK - MB, TNT were assessed by Spearman＇s rank - correlation analysis, and early diagnostic value of PAPP - A and CRP for ACS were compared by calculating the area under the ROC curve. Results The median PAPP - A and CRP levels were significantly higher in AMI and UAP groups than in the control and SAP groups（ P 〈0. 01 ,P 〈 0. 001 ）. There were no statistical significances in PAPP - A and CRP levels between UAP group and AMI group, between SAP group and control group （ P 〉 0.05 ）. The level of CRP significantly associated with the PAPP - A level in the patients with ACS（ r =0. 898 ,P 〈0. 01 ）. There was no significant relationship between the levels of PAPP - A and TNT, CK - MB. The area under the ROC curve for PAPP - A was 0. 91 ± 0.08, for CRP was 0.78 ± 0.05. Conclusion PAPP - A is a novel marker for the early diagnosis of ACS. PAPP - A levels associated with plaque stability and was predictive parameter for plaque stability, but it is not a marker for AMI.