非对称二甲基精氨酸测定在急性冠脉综合征中的临床应用价值

Clinical Application Value of Asymmetric Dimethyl-arginine in Acute Coronary Syndrome

目的探讨血浆非对称二甲基精氨酸(ADMA)浓度与急性冠状动脉综合征(ACS)及其不同亚组之间的相关性,以及对ACS的早期诊断价值。方法将随机选择的102例ACS患者根据临床诊断、心电图检查及冠状动脉造影结果,分为不稳定型心绞痛(UA)组(51例)、非ST段抬高性心肌梗死(NSTEMI)组(27例)和ST段抬高性心肌梗死(STEMI)组(24例),其中NSTEMI组和STEMI组又同属于急性心肌梗死(AMI)组;对照组(24例)为同期冠状动脉造影正常的患者。通过酶联免疫分析法(ELISA)测定血浆ADMA含量。结果 ACS组血浆ADMA浓度显著高于对照组,血浆ADMA浓度在UA和AMI两组间差异无统计学意义。ADMA的ROC曲线的曲线下面积AUC为0.813(0.7<A<0.9),cut-off值为5.28μg/L。结论 UA、NSTEMI、STEMI三组中血浆ADMA浓度皆升高,且有组间差异,血浆ADMA浓度对ACS有中等水平的诊断价值。

Objective To observe the relationship and clinical application value of plasma asymmetric dimethylarginine （ADMA） concentration and acute coronary syndrome （ACS） as well as its subgroups in patients. Methods All the patients were received coronary artery angiography. ACS group （n = 102） was divided into unstable angina （UA） sub group （ n = 51 ）, non-ST-segment elevation myocardial infarction （NSTEMI） subgroup （n =27） and ST-segment elevation myocardial infarction （STEMI） sub group （n = 24） according to clinical data, angiographie figure and electrocardiogram examination. The normal coronary patients provided as control group （n = 24）. The plasma ADMA was measured by enzyme linked immunosorbent assay （ELISA）. Results The concentration of plasma ADMA in ACS group was higher than in control group （P 〈0.05）. In sub- group analysis,the concentration of plasma ADMA in AMI group was higher than in control group （P 〈 0.05 ）. The concentration of plasma ADMA in UA group was higher than in control group （P 〈 0.05）. The concentration of plasma ADMA in NSTEMI group was higher than in control group （ P 〈 0.05 ）. The concentration of plasma ADMA in STEMI group was higher than in control group （P 〈 0.05 ）, and no differences were found between UA group and AMI group. Area Under ROC Curve of positive group and negative group was 0. 813（0.7 〈 A 〈0.9, and the cut-off was 15.28 ug/L. Conclusion The plasma ADMA concentration increased when ACS occurred. There was a medium level of diagnostic value of plasma ADMA in ACS.