联合检测生化标志物在急性冠脉综合症早期危险分层中的意义

Value of biochemical marker detection in risk stratification in patients with acute coronary syndrome

目的初步探讨联合监测多生化标志物在急性冠脉综合症住院患者危险分层中的意义。方法连续入选因胸闷、胸痛为主诉入院的患者264例(男180例,女84例),年龄64(55～69)岁。根据患者病情发展及变化,决定是否24h内行冠状动脉造影术(CAG)。将所有患者分为急诊CAG组和择期CAG组两组。每位患者在入院即刻抽取静脉血,分别检测氨基末端脑钠肽前体(NT-pro-BNP),超敏C反应蛋白(hs-CRP),髓过氧化物酶(MPO),单核细胞趋化蛋白-1(MCP-1),细胞间粘附分子(sICAM-1),可溶性CD40配体(sCD40L),基质金属蛋白酶9(MMP-9),白细胞介素6(IL-6),白细胞介素27(IL-27)及肌酸激酶同工酶(CK-MB)。结果①急诊CAG组和择期CAG组之间NT-proBNP,hs-CRP,MPO,sCD40L,MMP-9差异有统计学意义(P<0.05);②采用Logistic逐步回归,筛选出有统计学意义的生化标记物为NT-proBNP,hs-CRP,MPO,IL-27和CK-MB,建立预测ACS患者危险分层模型,进一步刀切法进行效果预测,并绘制ROC曲线,结果显示,ROC曲线下面积为98.1,提示该模型对ACS患者入院病情变化或发展具有较高的预测价值。结论联合检测生化标志物有助于对急性冠脉综合症住院患者进行早期危险分层。

Objective To assess the value of biochemical marker detection in risk stratification in hospitalized patients with acute coronary syndrome （ACS）. Methods A total of 264 consecutive patients （180 male and 84 female patients） admitted for complaint of chest tightness or/and pain were evaluated for a decision of coronary angiography （CAG） within 24 h after admission. The patients were divided into two groups to receive emergency or elective CAG. The venous blood samples were taken from the patient immediately after admission for detection of amino-terminal pro-brain natriuretic peptide （NT-pro-BNP）, high-sensitivity C-reactive protein （hs-CRP）, myeloperoxidase （MPO）, monocyte chemoattractant protein 1 （MCP-1）, intercellular adhesion molecule （sICAM-1）, soluble CD40 ligand （sCD40L）, matrix metalloproteinase 9 （MMP-9）, interleukin-6 （IL-6）, interleukin 27 （IL-27） and creatine kinase isoenzyme （CK-MB） were detected. Results No significant differences in NT-proBNP, hs-CRP, MPO, sCD40L, and MMP-9 were found between emergency CAG group and elective CAG group （P0.05）. Logistic regression identified significant differences in NT-proBNP, hs-CRP, MPO, IL-27 and CK-MB between the two groups, and a predictive model for risk stratification of ACS was established using these biomarkers. The ROC curves of this predictive model showed an area under the curve of 98.1, suggesting a high predictive value of this model in assessment of the changes or progression of ACS. Conclusion Combined detection of the biochemical markers can be helpful for risk stratification of the hospitalized patients with ACS early after admission.