颈动脉粥样硬化、血清妊娠相关蛋白A与不稳定型心绞痛的相关性

The relationship of carotid atherosclerosis,serum pregnancy-associated protein A and unstable angina

目的探讨颈动脉粥样硬化、血清妊娠相关性蛋白A与不稳定型心绞痛、稳定型心绞痛、非冠心病的相关性,进一步讨论联合颈动脉粥样硬化及妊娠相关性蛋白A预测不稳定型心绞痛的意义。方法因胸痛入院的患者1周内行冠脉造影,排除急性及亚急性心肌梗死,不稳定型心绞痛、稳定型心绞痛、非冠心病各40例被纳入研究中,进行冠状动脉Gensini评分,彩超检测颈动脉内中膜厚度、斑块形成情况,应用酶联免疫吸附法测定血清妊娠相关蛋白A水平,最后进行统计学分析。结果除吸烟史外,各组间其余基线资料匹配;不稳定型心绞痛、稳定型心绞痛组的冠脉Gensini评分、颈动脉粥样硬化指标均较非冠心病组高(P<0.001);不稳定型心绞痛组比稳定型心绞痛及非冠心病组血清妊娠相关蛋白A的浓度高(P<0.001),妊娠相关蛋白A在不稳定型心绞痛患者明显升高,其与颈动脉粥样硬化指标、冠脉Gensini积分正相关;Crouse积分预测心绞痛型冠心病,敏感度、特异度分别为0.79、0.92;颈动脉内中膜厚度平均值预测心绞痛型冠心病敏感度、特异度分别为0.97、0.85;妊娠相关蛋白A预测不稳定型心绞痛敏感度、特异度分别为0.825、0.937。结论颈动脉粥样硬化指标与冠状动脉Gensini积分有较好的相关性,而妊娠相关蛋白A可作为预测不稳定型心绞痛的指标;联合二者可能是预测不稳定型心绞痛的重要临床依据。

Objective This study aimed to investigate the relationship of carotid atherosclerosis, serum pregnancy- associated protein A （PAPP- A） , unstable angina （UAP） , stable angina peetoris（SAP） , and non -coronary heart disease （NCHD） , and discuss the joint signifi- cance of carotid atherosclerosis and PAPP - A concentration in the prediction of UAP. Methods Patients were admitted to hospital because of chest pain. Coronary angiography was completed within 1 week. After exclusion of the diagnosis of acute and subacute myocardial infarction, patients with UAP （ n = 40 ） , SAP （ n = 40） , and NCHD （ n = 40） were taken into the research. Gensini score, intima - media thickness （IMT） of carotid artery , plaque formation of carotid artery were determined by color doppler ultrasound, serum level of PAPP - A was determined by enzyme - linked immunosorbent assay （ ELISA）. The results were analyzed statistically. Results Except smoking history, baseline information of the groups matched each other. Coronary Gensini score and indicators of carotid atherosclerosis of UAP and SAP were higher than NHCD （ P 〈 0. 001 ）. Serum concentration of PAPP - A of UAP was higher than SAP and NHCD （ P 〈 0. 001 ）. PAPP - A in patients with UAP was significantly higher, and its concentration was positively correlated with indicators of carotid atherosclerosis and coronary artery Gensini score. For the prediction of angina - type CHD, the sensitivity and specificity of Crouse score were respectively 0.79 and 0.92, these values of the average of carotid IMT were respectively 0.97 and 0.85. For the prediction of UAP, the sensitivity and specificity of PAPP - A were respectively 0. 825 and 0. 937. Con- dusion Indicators of carotid atherosclerosis and coronary artery Gensini score are well correlated, and PAPP - A can be served as a predictable indicator of UAP. The combined use of these parameters may provide important clinical basis for the prediction of UAP.