血清炎性介质与冠状动脉粥样硬化性心脏病稳定性的关系

Association between the serum inflammatory markers and stability of coronary heart disease

【目的】从临床、造影和血清炎性介质方面综合评估冠状动脉粥样硬化斑块的稳定性。【方法】结合临床表现、心肌酶变化、冠脉造影结果,207例住院患者分为急性心肌梗死组(acute myocardial infarction,AMI)30例、不稳定心绞痛组(unstable angina,UA)90例、稳定性心绞痛组(stable angina,SA)36例和正常对照组(normal control,N)51例。采用酶联免疫吸附法测定血清高敏C反应蛋白(high sensitive C reactive protein,HsCRP)和妊娠相关蛋白A(pregnancy-associated plasma protein-A,PAPPA)。【结果】AMI组肌红蛋白(myoglobin,MYO)较对照组明显升高,肌钙蛋白(troponin I,TNI)和肌酸激酶同工酶(MB isoenzyme of creatine kinase,CKMB)无明显升高。AMI组HsCRP和PAPPA较对照组明显升高,具有统计学意义(P<0.05)。线性相关分析显示MYO和HsCRP、PAPPA无明显相关,HsCRP和PAPPA呈正相关(r=0.57,P=0.032)。【结论】急性心肌梗死组炎性介质水平升高,早期检验对预测斑块稳定性有一定意义。

[Objective]To evaluate the stability of coronary disease with clinical manifestation,coronary angiography（CAG）and the levels of serum inflammatory markers.[Methods] A total of 207 patients with chest pain were divided into 4 groups based on the clinical manifestation,ECG changes,myocardial markers and coronary angiography（CAG）：acute myocardial infarction AMI（n=30）,unstable angina UA（n=90）,stable angina SA（n=36）,normal CAG（n=51）.The serum levels of high sensitive C reactive protein and Pregnancy-associated plasma protein-A were measured in all the patients,and myocardial markers measured too.[Results] There were no difference either in Troponin Ⅰ（TNI）or MB isoenzyme of creatine kinase（CKMB）level,but the myoglobin（MYO）level was significantly increased in AMI than other groups.The serum level of Hs-CRP in AMI was higher only than normal group（7.41±9.91）mg/l vs（4.04±5.26）mg/l（P0.05）,and the serum level of PAPPA in AMI was higher than UA group,SA group and normal group respectively（P0.05）.[Conclusions] Serum level of Hs-CRP and PAPPA can be used as a good index reflecting the stability of coronary artery disease.