血清炎性因子联合检测对急性冠状动脉综合征的预测价值研究

Prediction Value of Combined Detection of Serum Inflammatory Factors in Acute Coronary Syndrome

目的研究血清炎性因子联合检测对急性冠状动脉综合征的预测价值。方法选择2011年7月至2013年9月海军总医院收治的稳定型心绞痛(SAP)、不稳定型心绞痛(UAP)、急性非ST段抬高型心肌梗死(NSTEMI)型、急性ST段抬高型心肌梗死(STEMI)患者及体检的健康者各40例,分别纳入研究的SAP组、UAP组、NSTEMI组、STEMI组和对照组,检测心肌酶谱指标肌酸激酶同工酶(CK-MB)、高敏心肌肌钙蛋白(hs-c Tn T)及炎性因子C反应蛋白(CRP)、基质金属蛋白酶9(MMP9)、金属蛋白酶组织抑制剂(TIMP)的水平。结果五组受试者心肌酶谱(CK-MB、hs-c Tn T)及炎性因子(CRP、MMP9、TIMP1、MMP9/TIMP1)的差异有统计学意义(P<0.05)。对照组、SAP组、UAP组、NSTEMI组、STEMI组CK-MB为(8.2±0.9)U/L,(8.5±1.1)U/L,(9.2±1.4)U/L,(29.2±4.6)U/L,(71.3±10.4)U/L;hs-c Tn T为(4.3±0.6)ng/L,(4.7±0.5)ng/L,(5.1±0.7)ng/L,(21.8±4.6)ng/L,(34.2±6.3)ng/L。SAP组、UAP组与对照组心肌酶谱比较差异无统计学意义(P>0.05),NSTEMI组、STEMI组显著高于对照组;UAP组与SAP组比较差异无统计学意义(P>0.05),NSTEMI组、STEMI组显著高于SAP组(P<0.05);NSTEMI组、STEMI组显著高于UAP组(P<0.05);STEMI组显著高于NSTEMI组(P<0.05)。对照组、SAP组、UAP组、NSTEMI组、STEMI组CRP为(5.1±0.7)mg/L,(5.3±0.6)mg/L,(11.8±2.4)mg/L,(31.2±4.2)mg/L,(55.8±6.9)mg/L;MMP9为(14.8±2.1)μg/L,(16.3±2.8)μg/L,(28.4±4.2)μg/L,(40.6±5.9)μg/L,(66.8±9.2)μg/L;TIMP1为(49.2±6.2)μg/L,(48.5±6.8)μg/L,(32.4±5.4)μg/L,(24.4±3.5)μg/L,(15.9±2.4)μg/L;MMP9/TIMP1为0.30±0.08,0.31±0.07,0.87±0.11,1.66±0.19,4.20±0.52。炎性因子:SAP组与对照组比较差异无统计学意义(P>0.05),UAP组、NSTEMI组、STEMI组显著高于对照组(P<0.05);UAP组、NSTEMI组、STEMI组显著高于SAP组(P<0.05);NSTEMI组、STEMI组显著高于UAP组(P<0.05);STEMI组显著高于NSTEMI组(P<0.05)。结论急性冠状动脉综合征患者血清中CRP、MMP9和TIMP1水平在UAP阶段即出现明显异常,联合检测是早期诊断疾病的理想指标。

Objective To study the prediction value of combined detection of serum inflammatory fac-tors in acute coronary syndrome.Methods Patients with stable angina pectoris（SAP）,unstable angina pec-toris（UAP）,non ST segment elevation acute myocardial infarction（NSTEMI）,STsegment elevation acute myocardial infarction（ STEMI） and healthy people received physical examination in PLA Navy General Hos-pital during Jul.2011 and Sep.2013 were collected and enrolled in SAP group,UAP group,NSTEMI group, STEMI group and control group.Myocardial enzymes Creatine Kinase MB （ CK-MB） ,high-sensitivity cardiac troponin T （hs-cTnT） and inflammatory factor CRP,MMP9,TIMP of the five groups were detected.Results There were significant difference in level of myocardial enzyme CK-MB, hs-cTnT and CRP, MMP9, TIMP1 and MMP9/TIMP1 among five groups（all P〈0.05）, level of CK-MB of control group,SAP group, UAP group,NSTEMI group and STEMI group were（8.2 ±0.9） U/L,（8.5 ±1.1） U/L,（9.2 ±1.4） U/L, （29.2 ±4.6） U/L,（71.3 ±10.4） U/L;hs-cTnT were（4.3 ±0.6） ng/L,（4.7 ±0.5） ng/L,（5.1 ± 0.7） ng/L,（21.8 ±4.6） ng/L,（34.2 ±6.3） ng/L.CK-MB, hs-cTnT in NSTEMI and STEMI group was significantly higher than those in the control group （P〈0.05）; CK-MB, hs-cTnT in NSTEMI and STEMI group were significantly higher than those in SAP group （ P 〈0.05 ）; CK-MB, hs-cTnT in NSTEMI and STEMI group was significantly higher than that in UAP group （P〈0.05）;CK-MB, hs-cTnT in STEMI group was significantly higher than that of NSTEMI group （P〈0.05）.Level of CRP of control group,SAP group, UAP group ,NSTEMI group and STEMI group were （5.1 ±0.7） mg/L,（5.3 ±0.6） mg/L,（11.8 ±2.4） mg/L,（31.2 ±4.2） mg/L,（55.8 ±6.9） mg/L;MMP9 （14.8 ±2.1） μg/L,（16.3 ±2.8） μg/L,（28.4 ± 4.2） μg/L,（40.6 ±5.9） μg/L,（66.8 ±9.2） μg/L;TIMP1 （49.2 ±6.2） μg/L,（48.5 ±6.8） μg/L, （32.4 ±5.4） μg/L,（24.4 ±3.5） μg/L,（15.9 ±2.4） μg/L;MMP9/TIMP1 0.30 ±0.08,0.31 ±0.07, 0.87 ±0.11 ,1.66 ±0.19 ,4.20 ±0.52.Inflammatory factor in the UAP group , NSTEMI and STEMI group was significantly higher than that of control group （P〈0.05）;Inflammatory factor in UAP group, NSTEMI group and STEMI group was significantly higher than that of SAP group （P〈0.05）;Inflammatory factor in NSTEMI group and STEMI group was significantly higher than that in UAP group （ P〈0.05 ）;Inflammatory factor in STEMI group was significantly higher than that of NSTEMI group （P〈0.05）.Conclusion Serum content of CRP,MMP9 and TIMP1 in acute coronary syndrome patients are obviously abnormal in the stage of UAP and combined detection is an ideal approach for early diagnosis of diseases.