妊娠相关血浆蛋白-A、缺血修饰白蛋白在急性冠脉综合征早期诊断中的价值

Predictive Role of Pregnancy-associated Plasma Protein-A and Ischemia-Modified Albumin in Early Diagnosis of Acute Coronary Syndrome

【目的】探讨妊娠相关血浆蛋白-A(PAPP-A)及缺血修饰白蛋白(IMA)在急性冠脉综合征(ACS)早期诊断中的意义。【方法】87例疑似ACS患者在胸痛发作3h内采取静脉血测定PAPP-A、IMA及相关指标并进行分析。经冠状动脉造影证实冠脉正常者作为对照组27例,稳定性心绞痛(SAP)组20例,ACS组40例,包括不稳定性心绞痛(UAP)23例、急性心肌梗死(AMI)17例。【结果】①ACS组中PAPP-A及IMA含量(16.19±2.13mIU/L,0.608±0.097ABSU)明显高于SAP组(4.720±1.960mIU/L,0.436±0.022ABSU)及对照组(4.390±1.150mIU/L,0.246±0.135ABSU)(P<0.001),IMA与PAPP-A呈显著正相关(r=0.80,P<0.01)。②PAPP-A及IMA对检测ACS早期的灵敏度分别为85%及80%,两者联合灵敏度达95%。【结论】PAPP-A及IMA在外周血中明显升高,可能是ACS早期的预测因子,两者联合检测可提高对ACS早期诊断能力。

[Objective]To explore the significance of pregnancy-associated plasma protein A（PAPP-A） and ischemia modified albumin （IMA）in the early diagnosis of acute coronary syndrome（ACS）. [Methods]Eighty seven patients with acute chest pain within 3 hours were included in the study. Values of PAPP-A, IMA and cardiac troponin I（cTnI） were tested and analyzed. Electrocardiogram （ECG） was recorded in patients. Twenty seven controls with normal coronary angiography and 20 patients with stable angina,40 patients with ACS including 23 with unstable angina and 17 with acute myocardial infarction were studied. IMA was measured by the albumin cobalt binding test （ACB Test）. [Results]Mean serum PAPP-A and IMA levels were significantly higher in ACS patients（16.19±2.13mlU/L,0. 608±0. 097ABSU） than those in stable angina patients（4. 720±1. 960mIU/L,0. 436±0. 022ABSU）and the controls（4. 390±1. 150mIU/L,0. 246±0. 135 ABSU）（P〈0.001）. IMA level was positive correlation with level of PAPP-A in ACS. Sensitivity of PAPP A and IMA for ACS was 85% and 80% respectively. Combining results of PAPP-A and IMA produced a sensitivity of 95%. [Conclusion]The elevated levels of PAPP-A and IMA may be the predictive marker of ACS. PAPP-A could improve the early diagnosis of acute coronary syndrome combined to IMA.