和肽素在急性胸痛患者中的表达及意义

Expression and Significance of Copeptin in Patients with Acute Chest Pain

目的：探讨和肽素在急性胸痛患者中的表达及意义。方法：选取2010年12月—2012年6月就诊的急性胸痛患者491例,其中男性278例,女性213例;年龄（54±15）岁;采用酶联免疫吸附试验检测所有患者血清中和肽素。选取性别、年龄匹配的30例健康志愿者作为对照组,其中男性17例,女性13例;年龄（51±13）岁;检测其血清中和肽素水平。结果：491例急性胸痛的患者中,急性心肌梗死49例（9.98%）,不稳定性心绞痛126例（25.66%）,心源性疾病但非冠心病85例（17.31%）,主动脉夹层10例（2.04%）,肺栓塞8例（1.63%）,气胸或纵隔气肿26例（5.30%）,胸膜炎47例（9.57%）,肺部肿瘤19例（3.87%）,肋神经炎或肋软骨炎58例（11.81%）,带状疱疹18例（3.67%）,植物神经功能紊乱38例（7.74%）,消化道疾病7例（1.42%）;其中急性心肌梗死患者的和肽素水平（中位数：0.590 ng/mL,四分位距：0.340-0.990）明显高于其他组,差异均有统计学意义（P〈0.001）。急性胸痛患者按照疾病大类分组,心血管疾病患者和肽素水平（中位数：0.198 ng/mL,四分位距：0.133-0.281）明显高于其他疾病患者,差异均有统计学意义（P〈0.001）。结论：和肽素在急性心肌梗死患者血清中的水平明显高于其他原因胸痛患者;对于急性胸痛患者,和肽素具有明显的诊断和鉴别诊断意义,可提高急性心肌梗死的诊断率。

Objective：To investigate the expression and significance of copeptin in patients with acute chest pain.Methods： From Dec 2010 to Jun 2012,a total of 491 patients with acute chest pain have been enrolled,including 278 males and 213 females,with an average age of（54±15）years old.A total of 30 age and gender matched healthy volunteers were also enrolled in the trail,including 17 males and 13 females,and their average age was（51±13）years.The copeptin levels in blood samples were detected by enzyme-linked immunosorbent assay（ELISA）in both groups.Results：In 491 patients with acute chest pain,there were 49 patients with acute myocardial infarction（9.98%）,126 patients with unstable angina（25.66%）,85 patients with cardiogenic but non-coronary heart diseases（17.31%）,10 patients with aortic dissection（2.04 %）,8 patients with pulmonary embolism（1.63%）,26 patients with pneumothorax or mediastinal emphysema（5.30 %）,47 patients with pleurisy（9.57 %）,19 patients with lung tumors（3.87%）,58 patients with rib neuritis or costochondritis（11.81%）,18 patients with herpes zoster（3.67%）,38 patients with autonomic dysfunction（7.74%）,and 7 patients with abdominal disease（1.42 %）.Compared to other diagnostic groups,the distinctly elevated copeptin level in patients with acute myocardial infarction（median：0.590 ng/ mL,IQR：0.340-0.990）was statistically significant（P〈0.001）.Dividing the patients with acute chest pain according to major categories,the copeptin level in patients with cardiovascular diseases（median：0.198 ng/mL,IQR：0.133-0.281）was significantly higher than those in patients with other diseases（P〈0.001）.Conclusions：Compared to the patients whose chest pain is caused by other relevant reasons,the copeptin levels are significantly higher in patients with acute myocardial infarction.Copeptin has obvious significance in the diagnosis and differential diagnosis and thus can increase the accuracy of diagnosis of acute myocardial infarction for patients with acute chest pain.