肝素结合蛋白在ST段抬高性急性心肌梗死中的临床意义

Clinical Significance of Heparin- binding Protein in Patients with ST- segment Elevated Acute Myocardial Infarction

目的 观察肝素结合蛋白（HBP）在急性冠脉综合征（ACS）患者血浆中的变化,探讨其在ST段抬高性急性心肌梗死（STEAMI）预测和预后评价中的意义.方法 分别测定47例STEAMI、33例非ST段抬高性急性冠脉综合征（NSTEACS）,32例稳定型心绞痛（SAP）患者和35例健康人员HBP和肌钙蛋白Ⅰ（TnⅠ）浓度,分析二者的相关性,并以ROC曲线评价HBP和TnⅠ对STEAMI的诊断价值.结果 NSTEACS组HBP和TnⅠ水平均显著高于SAP组和正常对照组（P=0.000）,但显著低于STEAMI组（P =0.000）.NSTEACS组和STEAMI组HBP与TnⅠ均呈显著正相关（r=0.778和0.797,P＜0.01）.HBP和TnⅠ在STEAMI中的ROC曲线下面积分别为0.937（95％ CI：0.889 ～0.986）和0.912（95％ CI：0.852 ～0.973）;HBP诊断界值为8.55ng/ml,敏感度为89.4％,特异性为75.8％.STEAMI死亡组治疗前HBP水平和阳性率均显著高于存活组（P＜0.01）,但两组TnⅠ水平和阳性率差异无统计学意义（P＞0.05）.结论 HBP可作为预测STEAMI的敏感指标,并对STEAMI患者的预后评价具有重要意义.

Objective To observe the alteration of heparin - binding protein （HBP） in patients with acute coronary syndrome （ACS） , and to explore its clinical significance in prediction and prognosis of ST segment elevated acute myocardial infarction（ STEAMI）. Methods Forty- seven patients with STEAMI, 33 patients with NSTEACS, 32 patients with stable angina pectoris （SAP）, and 35 healthy volunteers were involved. HBP and troponin I （Tnl） were measured. The correlation between HBP and TnI was analyzed. And the receiver operating characteristic （ROC） curve was used to evaluate the diagnostic value of HBP and TnI in STEAMI. Results At group NSTEACS, levels of HBP and TnI were significantly higher than those at group SAP and group healthy volunteers, but were signifi- cantly lower than those at group STEAMI （ P 〈 0. 001 ）. There was sinificantly positive correlation between HBP and TnI at group NSTEACS and STEAMI（P 〈0. 001 ）. The area under ROC curve of HBP and TnI in STEAMI was O. 937,95% CI：0. 889 -0. 986 and 0. 912,95% CI：0. 852 -0. 973, respectively. With the optimal cutoff value of 8.55ng/ml for HBP, the sensitivity and specificity was 89.4% and 75.8% , respectively. HBP level and positive rate at group STEAMI non - survival was notably higher than that at group sur- vival （ P 〈 0. 001 ） , but there was no significantly difference for TnI level and positive rate between the two groups（ P 〉 0. 05 ）. Conclusion HBP is a more sensitive marker for the prediction of ST - segment elevated acute myocardial infarction. There is important significance for HBP in prognosis evaluation of STEAMI patients.