超敏妊娠相关血浆蛋白-A对急性冠状动脉综合征患者预后的预测价值

Prognostic Value of Ultra-sensitive Pregnancy Associated Plasma Protein-A in Patients with Acute Coronary Syndorme

目的评估发病早期外周血超敏妊娠相关血浆蛋白-A(PAPP-A)水平对急性冠状动脉综合征(ACS)患者预后的预测价值。方法筛选明确诊断的ACS患者480例,测定入院首次(发病<12 h)外周血PAPP-A水平,并随访观察第1、6个月和≥12个月时心血管不良事件。根据PAPP-A最高5分位水平,将患者分为高值组(≥26.08μg/L)和低值组(<26.08μg/L),分析PAPP-A水平和心血管不良事件的关系。结果与PAPP-A低值组相比,PAPP-A高值组患者的复合终点事件发生率随着随访时间明显增加,其第1、6个月和≥12个月的OR值分别为4.76、4.38、3.75,差异均有统计学意义(P=0.000);其中PAPP-A高值组患者的心肌梗死(MI)+心因性死亡(CD)事件在第1、6个月和≥12个月的OR值分别为为9.81、6.08、4.12,差异有统计学意义(P<0.01)。多因素Logistic回归分析显示,PAPP-A是ACS患者近期、中期和远期发生心血管不良事件的独立危险因素(P<0.05)。结论发病早期PAPP-A水平升高是ACS患者再发心血管不良事件的独立危险因素。

Objective To investigate the prognostic value of ultra-sensitive pregnancy associated plas- ma protein-A （PAPP-A） level in the early phase of acute coronary syndrome （ACS） attack. Methods Pa- tients diagnosed as ACS were enrolled and the level of circulatory PAPP-A was measured within 12 hours after ACS attack. The patients were followed at the time of 1 st, 6th, and 12th months post-ACS attack in order to observe the incidence of the cardiovascular adverse events. According to the highest quintile, the patients were derided into 2 groups： high level （ ≥26.08 μg/L） group and low level （ 〈26, 08 μg/L） group, to evaluatethe association between the level of PAPP-A and the incidence of the cardiovascular events. Results Com- pared with the low level group, the incidence of the composite outcome is significantly increased in the high level group, and the values of OR are 4. 76, 4.38, 3.75 for 1st, 6th, 12th months respectively （P = 0. 000）. For myocardial infarction （MI） ＋ cardiac death （CD） the values of OR were 9. 81, 6.08, 4. 12 （P 〈 0.01 ）. Multivariate logistic regression analysis demonstrates that PAPP-A was an independent risk factor for the cardio- vascular adverse events in the early, median, and late phase of ACS （P 〈 0.05 ）. Conclusion In the early phase of ACS attack, the elevation of PAPP-A is an independent risk factor for the occurrence of cardiovascular adverse events.