血清肌钙蛋白、高敏C反应蛋白、基质金属蛋白酶9、同型半胱氨酸诊断老年急性冠状动脉综合征的价值

Application of serum cardiac troponin I,high-sensitivity C-reactive protein,matrix metalloproteinases-9 and homocysteic acid in elderly with acute coronary syndrome

目的探讨老年急性冠状动脉综合征(ACS)患者中血清心肌钙蛋白I(cTnI)、高敏C反应蛋白(hs-CRP)、基质金属蛋白酶9(MMP-9)和同型半胱氨酸(HCY)的应用价值。方法随机抽取2007～2009年就诊于黑龙江省医院心内科住院患者158例(年龄≥65岁)行冠状动脉造影,并根据2000年美国心脏病协会(AHA)和美国心脏病学会(ACC)的诊断标准将患者分为72例ACS患者、48例稳定性心绞痛(SAP)患者和正常对照组38例。采用ELISA法测定所有受试者血清cTnI、hs-CRP、MMP-9和HCY水平,分别比较四者在各组间的水平,并分析四者间的相关性。结果 (1)血清cTnI、hs-CRP、MMP-9和HCY在ACS组浓度均明显高于其他两组,而且三组间的两两比较,差异均有统计学意义(P<0.001);(2)ACS人群中发现,cTnI在UAP组明显低于NSTMI和STMI组,而HCY水平在STMI组最高;(3)血清cTnI与hs-CRP、MMP-9和HCY密切相关,相关系数分别为0.412(P<0.0001)、0.532(P<0.0001)和0.625(P<0.0001)。结论血清hs-CRP、MMP-9和HCY可作为与cTnI联合检测老年ACS的血清学指标。

Objective To explore the application of serum cardiac troponin I（cTnI）,high-sensitive C-reactive protein（ hs-CRP ）,matrix metalloproteinases-9（ MMP-9 ） and homocystine （ HCY ） in elderly patients（age≥65） with acute coronary syndrome （ACS）.Methods One hundred fifty-eight inpatients who attended Department of Cardiology of Hospital of Heilongjiang Province from 2007 to 2009 were selected randomly,including 72 ACS patients,48 SAP patients and 38 individuals without coronary heart disease as normal controls.All subjects underwent coronary arteriongraphy.The concentrations of cTnI,hs-CRP,MMP-9 and HCY were determined using Enzyme Linked Immuno Sorbent Assay （ELISA） and were compared in ACS group,SAP group and normal controls.Further the concentrations were compared in the subtypes of ACS also.Correlation analysis were used to examine the relationships between serum cTnI,hs-CRP,MMP-9 and HCY.Results The concentrations of cTnI,hs-CRP,MMP-9 and HCY were considerably higher in ACS group than those in other two groups,which were significant differences between SAP group and normal controls also （P0.001）.It was found in ACS group that the level of cTnI was significantly lower in patients with UAP than those in patients with NSTMI and STMI,while the level of HCY was highest in STMI group.Pearson and Spearsman correlation analysis indicated that cTnI related to hs-CRP,Conclusions Serum hs-CRP,MMP-9 and HCY,espeically HCY,may be the serological index,combining with serum cTnI,in elderly patients with ACS.