生化标志物联合检测对急性冠脉综合征早期诊断的意义

Joint detection of biochemical markers in early diagnosis of acute coronary syndrome

目的:探讨生化标志物联合检测在急性冠脉综合征(acute coronary syndromes,ACS)的早期诊断价值。方法:因胸痛发作3 h内就诊患者分为ACS组和非缺血性胸痛(non-ischemic chest pain,NICP)组,在胸痛0～3 h和3～6 h分别抽血采用ELISA等方法检测骨髓相关蛋白(Myeloid-re-lated protein,MRP)、妊娠相关蛋白A(pregnancy-associatedplasma protein A,PAPP-A)、肌酸激酶同工酶MB(creatine ki-nase-MB,CK-MB)和肌钙蛋白I(cardiac troponin I,cTnI)四项指标。评价MRP与PAPP-A、CK-MB、cTnI联合检测在ACS的早期诊断价值。结果:MRP诊断发病3 h内ACS的灵敏度为57.4%,高于PAPP-A(8.2%)、CK-MB(21.3%)和cTnI(18.0%)。四项指标联合诊断ACS的灵敏度提高到75.4%。MRP诊断发病3～6 h ACS的灵敏度为78.7%,也高于PAPP-A(39.3%)、CK-MB(49.2%)和cTnI(45.9%)。四项指标联合诊断ACS的灵敏度提高到96.7%。结论:MRP对ACS诊断的灵敏度高于PAPP-A、CK-MB、cTnI,可作为诊断ACS的早期生化标志物。四项指标联合检测可提高ACS的早期诊断。

Objective：To investigate the value of combined detection of biochemical markers in the early diagnosis of acute coronary syndrome（ACS）.Methods： Eighty-one patients were divided into group ACS（patients paid hospital visit within 3 hours of the acute chest pain） and non-ischemic chest pain（NICP）.Blood samples were obtained respectively during pain attack of 0 to 3h and 3h to 6h,and detected for myeloid-related protein（MRP）,pregnancy-associated plasma protein A（PAPP-A）,creatine kinase MB（CK-MB） and cardiac troponin I（cTnI） by ELISA to estimate the diagnostic value of the four biochemical markers in ACS.Results： MRP sensitivity for ACS within 3 hours of attack was 57.4% compared to 8.2% of PAPP-A,21.3% of CK-MB and 18.0% of cTnI.Combined biochemical markers of the four could identify 75.4% of ACS.Sensitivity of MRP for ACS between the attack of 3 to 6 hours was 78.7% compared to 39.3% of PAPP-A,49.2% of CK-MB and 45.9% of cTnI,Yet,when the four biochemical markers were in joint consideration,accurate diagnosis of ACS could be 96.7%.Conclusion： Although single marker of MRP may be more sensitive compared with PAPP-A,CK-MB and cTnI,combined detection of the four biochemical markers can be of greater importance in early diagnosis of ACS.