妊娠相关血浆蛋白-A对急性冠脉综合征诊断价值的研究

The study on the diagnostic value of pregnancy-associated plasma protein-A in acute coronary syndrome patients

目的探讨妊娠相关血浆蛋白-A（PAPP—A）对急性冠脉综合征（ACS）患者的诊断价值。方法选择49例经冠状动脉造影证实的心肌肌钙蛋白I（cTnI）阴性的冠心病患者，其中ACS患者31例（ACS组），稳定型心绞痛（SAP）患者18例（SAP组），另选择28例冠状动脉造影正常者作为对照组。采用酶联免疫吸附法检测各组血清PAPP-A和超敏C反应蛋白（hs-CRP）水平。结果（1）ACS组PAPP-A和hs-CRP水平较SAP组、对照组均显著增高（P〈0．05）。（2）以PAPP-A 2．79μg／L作为ACS的阳性诊断标准，其灵敏度为81．0％，特异度为84．6％。ROC曲线下面积为0．9，95％可信区间为0．82～0．99。（3）ACS组hs—CRP水平与PAPP-A水平呈正相关（r=0．418，P〈0．01）。结论PAPP-A可作为诊断ACS的指标之一，对于cTnI阴性的ACS患者尤其有价值。

Objective To investigate the diagnostic value of pregnancy-associated plasma protein-A （PAPP-A） in acute coronary syndrome （ACS） patients. Methods Forty-nine cTnI-negative patients with coronary artery disease who were documented by angiography [31 cases with ACS, 18 cases with stable angina （SAP）], and 28 healthy persons were selected as controls. PAPP-A and hs-CRP were analysed with enzyme-linked immunosorbent assay （ELISA）. Results Circulating PAPP-A and hs-CRP levels were significantly higher in patients with ACS than those in patients with SAP and controls （P 〈 0.05）. PAPP-A threshold value of 2.79 μg/ml identified patients who had ACS with a sensitivity of 81.0% and a specificity of 84.6%. PAPP-A levels were correlated with hs-CRP levels in patients with ACS （r = 0.418, P 〈 0.01 ）. Conclusion PAPP-A is a strong candidate marker of ACS, especially to cTnl-negative patients.