妊娠相关蛋白A在急性冠脉综合征中的临床应用价值

The clinical value of pregnancy associated protein A in patients with acute coronary syndrome

目的探讨妊娠相关蛋白A（PAPP．A）在急性冠脉综合征（ACS）中的诊断价值。方法选取2008至2009年同济大学附属东方医院心内科住院ACS患者249例，其中sT段抬高的心肌梗死（STEMI）组患者50例，非sT段抬高的心肌梗死（NSTEMI）组患者43例，不稳定型心绞痛（UAP）组患者156例；根据冠脉病变支数分为单支病变组、双支病变组和三支病变组；同时选取205名健康体检者作为对照组。采集患者及健康对照者静脉血标本，每份标本同时采用电化学发光法测定PAPP—A、肌酸激酶同工酶（CK—MB）、高敏肌钙蛋白（hs—TnT），采用免疫散射比浊法测定超敏c反应蛋白（hs—CRP）。采用方差分析及Kruskal—WallisH检验进行统计学分析。结果STEMI组、NSTEMI组、UAP组及健康对照组血清PAPP—A浓度分别为10．45（5．54—16．08）、6．56（4．68—9．55）、5．70（4．12～8．50）、5．23（4．00～5．88）mIU／L，差异有统计学意义（H=43．94，P〈0．01）；两两比较显示，STEMI组、NSTEMI组、UAP组PAPP—A浓度均显著高于健康对照组，差异均有统计学意义（t=6．80、2．46、1．72，P均〈0．05）。PAPP—A诊断ACS的敏感度为52．2％，特异度为80％，在hs—TnT阴性的患者中，PAPP—A阳性率为44．5％（69／155）。冠脉三支病变组PAPP—A浓度为7．72（5．03～12．46）mIU／L，显著高于单支病变组的5．35（4．14～8．59）mIU／L，双支病变组的6．05（4．42～9．58）mIU／L，差异均有统计学意义（t=2．00、1．57，P均〈0．05）。ACS患者PAPP-A水平与hs—CRP呈显著正相关（r=0．524，P〈0．05），与CK—MB、hs—TnT相关性较弱（r=0．326、0．343，P均〈0．05）。结论ACS患者血清PAPP—A浓度明显升高，可作为ACS斑块不稳定性的血清学标志物，对hs—TnT阴性的ACS患者具有一定的诊断价值。

Objective To investigate the clinical value of pregnancy-associated plasma protein A （PAPP-A） in patients with acute coronary syndrome （ACS）. Methods The study subjects comprised of 249 patients with ACS [50 patients with ST elevation acute myocardial infarction（STEMI） , 43 patients with non-ST elevation acute myocardial infarction （NSTEMI）, 156 patients with unstable angina pectoris （UAP） I from July 2008 to December 2009 at Shanghai East Hospital affiliated to Tongji University. The patients were divided into single-vessel lesions group, double-vessel lesions group and three-vessel lesions group according to the coronary artery stenosis. A group of 205 healthy subjects admitted for health physical examination were used as controls. Blood samples were collected from ACS patients and control subjects. Serum PAPP-A, creatine kinaseisoenzyme MB （CK-MB） , high-sensitivity troponin-T （hs-TnT） were measured by electrochemiluminesence and high-sensitivity C-reactive protein （hs-CRP） was measured by immune scatter turbidity method. Analysis of variance ANOVA and Kruskal-Wallis H test were used for statistical analysis. Results Serum PAPP-A in the STEMI, NSTEMI, UAP and normal control group were 10.45（5.54- 16.08）, 6.56（4.68- 9.55）, 5.70（4.12-8.50）, 5.23（4.00-5.88） mIU/L,respectively, and the difference was statistically significant （H = 43.94, P 〈 0. 01 ）. Pairwise comparison showed that PAPP-A in STEMI, NSTEMI, UAP were significantly higher than the healthy control group and differences were statistically significant （ t = 6. 80, 2.46, 1.72, P 〈 0. 05 ）. The PAPP-A had a sensitivity of 52. 2% and specificity of 80% in diagnosis of ACS. The positive rate of PAPP-A was 44. 5% （69/155） in patients with negative hs-TnT. The serum levels of PAPP-A in the three-vessel lesions group [ 7.72 （5.03 - 12. 46） mlU/L] was higher than that in the single, double groups [ 5.35 （ 4. 14 - 8.59 ）, 6.05 （ 4. 42 - 9.58 ） mlU/L ], and the difference had statistical significance （t = 2. 00,1.57, P 〈 0.05 ）. There was obvious correlation between the level of serum PAPP-A and the level of hs-CRP （ r = 0. 524, P 〈 0. 05 ） , and there was weak correlation between the PAPP-A and CK-MB or hs-TnT （r =0. 326, 0. 343, P 〈0. 05）. Conclusions The results shows that PAPP-A is elevated in patients with ACS. It may be used as a serum biomarker for vulnerable plaques in patients with ACS and has a clinical value for ACS diagnosis especially in patients with negative hs-TnT.