冠心病患者PCI手术前后血清髓过氧化物酶水平变化及临床意义

The changes of serum myeloperoxidase in patients with coronary heart disease pre and post intervention treatment

目的：探讨冠心病（ CHD）患者经皮冠状动脉介入术（ PCI）治疗前后血清髓过氧化物酶（ MPO）水平变化及临床意义。方法成功行PCI治疗的CHD患者80例（ CHD组），其中稳定型心绞痛（ SAP亚组）50例，不稳定型心绞痛（ UAP亚组）患者30例，又根据冠状动脉Gensini积分分为重度病变亚组32例和非重度病变亚组48例；另选取非CHD志愿者20例为健康对照组。观察PCI术前及术后1 h和24 h时血清MPO水平改变，综合分析MPO改变与临床各指标的关系。结果 SAP亚组和UAP亚组患者术前MPO和CRP水平均高于健康对照组（ P ＜0蜒．05）。与术前比较，PCI术后1 h MPO水平上升（ P ＜0．05），24 h回落。重度病变亚组患者术前MPO和CRP水平均高于非重度病变亚组（ P ＜0．05）。经PCI治疗后，重度病变亚组PCI术后1 h水平仍明显高于非重度病变亚组（ P ＜0．05）。ROC分析可见术后24 h和△1（术后1 h－术前）、△3（术后24 h－术后1 h）的MPO水平有助于预测MACE的发生（AUC分别为0．823、0．769和0．845， P ＜0．05）。△1（术后1 h－术前）与MACE存在正相关（ r ＝0．372， P ＜0．05），与Gensini积分存在正相关（ r ＝0．392， P ＜0．05），△3（术后24 h－术后1 h）与MACE存在负相关（ r ＝－0．329， P ＜0．05），与Gensini积分存在负相关（ r ＝－0．435， P ＜0．05）。 Logistic回归发现Gensini积分（OR＝1．03，95％CI 0．92～1．32， P ＜0．05）和△3（OR＝1．12，95％CI 0．94～1．45， P ＜0．05）为MACE发生的独立危险因素。结论 PCI术后CHD患者血清MPO出现一过性波动，这种改变与冠状动脉狭窄程度和临床预后相关。

Objective To investigate the changes of serum myeloperoxidase （ MPO） level and its clinical significance in patients with coronary heart disease （ CHD） pre and post percutaneous coronary intervention （ PCI） .Methods Eighty ca-ses of successful PCI patients were enrolled as CHD group, among them, 50 cases of stable angina pectoris were enrolled as SAP subgroup, 30 patients with unstable angina pectoris were enrolled as UAP subgroup, and according to coronary Gensini score, they were divided into severe lesions subgroup （ n =32） and non-severe leisions subgroups （ n =48）;selected non-CHD volunteers 20 cases as healthy control group.The changes of serum MPO levels before and 1 h and 24h post PCI were observed,the relationship between these clinical indexes were analyzed .Resu lts The SAP subgroup and UAP subgroup ’ s MPO and CRP levels were higher than those in healthy control group （ P 〈0.05）.Compared with pre PCI, 1 h post PCI, MPO level were increased （ P 〈0.05） , after 24h, it was felled.Severe lesions subgroups’ preoperative MPO and CRP levels were higher than those in non-severe lesion group （ P 〈0.05）.After PCI treatment, the severe lesion group after PCI 1h ’s level were still significantly higher than the non-severe lesion group （ P 〈0.05）.After 24 h and △1 （after 1 h to before PCI ） ,△3 （ postoperative 24 h to 1 h after operation） , ROC analysis revealed that the levels of MPO helped to predict MACE （AUC were 0.823, 0.769 and 08.45 respectively, P 〈0.05）.△1 （1 h after PCI to before PCI） and MACE exist positive correlation （ r =0.372, P 〈0.05）,△1 and the Gensini score exists positive correlation （ r =0.392, P 〈0.05）.△3 （24 h after PCI to 1 h after PCI） and MACE exist negative correlation （ r =-0.329, P 〈0.05）, there is a negative correla-tion with Gensini score （ r =-0.435, P 〈0.05）.Logistic regression analysis indicated that the Gensini score （OR=1.03, 95%CI 0.92-1.32, P 〈0.05） and△3 （OR=1.12, 95%CI 0.94-1.45, P 〈0.05） were independent risk factors of MACE.Conclusion After PCI, serum MPO showed fluctuation in CHD patients.This change correlated with the severity of coronary artery stenosis and clinical prognosis.