联合检测MPO、IL-6和hs-CRP对冠心病危险分层的价值

Value of risk stratification of coronary heart disease by combined determination of myeloperoxidase,interleukin-6 and high sensitivity C-reactive protein

目的探讨联合检测3种血清炎性标志物对冠心病危险分层的价值。方法对381例住院冠心病患者[急性心肌梗死(acute myocardial infarction,AMI)105例,不稳定性心绞痛(unstable angina pectoris,UAP)162例,稳定性心绞痛(stable angina pectoris,SAP)114例]和337例对照组[非冠心病患者(non-coronary heart disease,NCHD)187例和健康体检者150例],分别用选择抑制法检测血清髓过氧化物酶(myeloperoxidase,MPO)、微粒子化学发光免疫法检测白细胞介素-6(IL-6)、免疫荧光分析法检测超敏C反应蛋白(hs-CRP)。结果急性冠脉综合征(acute coronary syndromes,ACS)组MPO、IL-6、hs-CRP均显著高于SAP、NCHD和健康组(P=0.000)。MPO以AMI组最高,UAP组其次,SAP组再次,均明显高于NCHD和健康组(P<0.05)。UAP组与SAP组IL-6水平差异无统计学意义(P>0.05),但明显低于AMI组,高于NCHD及健康组(P<0.05)。SAP、NCHD、健康体检者3组间hs-CRP无统计学差异,但显著低于UAP组及AMI组(P<0.05)。AMI患者MPO多轻度升高(89.52%)并伴IL-6和hs-CRP重度升高(分别达90.48%和96.19%),UAP患者MPO多轻度升高(80.86%)并伴IL-6和hs-CRP中度升高(分别为67.28%和78.40%)。SAP患者MPO和hs-CRP轻度升高率分别为48.25%和53.51%,IL-6中度升高率为54.39%。单项炎性标志物对ACS的诊断灵敏度均较高,但特异性均不理想。串联分析3种炎性标志物诊断ACS的灵敏度、特异性、阳性预测值、阴性预测值和准确度分别为74.53%、79.82%、89.64%、57.23%和76.12%。结论联合检测MPO、IL-6和hs-CRP可鉴别诊断冠心病不同病理阶段,提高诊断ACS的特异性和阳性预测值,有助于冠心病的危险分层。

Objective To study the value of risk stratification of coronary heart disease（CHD） by combined detection of three inflammatory markers of myeloperoxidase（MPO）,interleukin-6（IL-6） and high sensitivity C-reactive protein（hs-CRP）.Methods Serum levels of MPO,IL-6 and hs-CRP were respectively measured by selective repression method,microparticle chemiluminescent immunoassay and immunofluorescence analysis in 381 CHD patients [105 acute myocardial infarction（AMI）,162 unstable angina pectoris（UAP） and 114 stable angina pectoris（SAP）] and in 337 people who were set as controls [187 non-coronary heart disease（NCHD） and 150 healthy subjects].Results Levels of MPO,IL-6 and hs-CRP in the acute coronary syndromes（ACS） group（AMI group＋UAP group） were significantly higher than those in the SAP,NCHD and healthy groups（P=0.000）.AMI patients had the highest activity of MPO,UAP patients were the second highest,and SAP patients were the third highest as compared with those of the NCHD and healthy groups（P0.05）.IL-6 levels of the UAP and SAP groups had no significant difference（P0.05）,but were significantly lower than those of the AMI group and higher than those of the NCHD and healthy groups（P0.05）.There was no significant difference in serum levels of hs-CRP among the SAP,NCHD and healthy groups,but their hs-CRP levels were significantly lower as compared with those of the UAP and AMI groups（P0.05）.About 89.52% AMI patients had slightly elevated MPO with severely elevated IL-6 and hs-CRP（90.48% and 96.19%,respectively）.Of 80.86% UAP patients had slightly elevated MPO with moderately elevated IL-6 and hs-CRP（67.28% and 78.40%,respectively）.SAP patients had slightly elevated of MPO and hs-CRP（48.25% and 53.51%） with moderately elevated IL-6（54.39%）.Each tested inflammatory marker had a high diagnostic sensitivity for ACS,but the specificity was unsatisfactory.The diagnostic efficiency of combined detection of the three inflammatory markers by serial tests for ACS were 74.53% for sensitivity,79.82% for specificity,89.64% for positive predictive value,57.23% for negative predictive value and 76.12% for accuracy,respectively.Conclusion Combined detection of MPO,IL-6 and hs-CRP can be used in diagnosis of CHD at different pathological stages and improve the specificity and positive predictive value for diagnosing ACS,which is helpful for the risk stratification of CHD.