生物标志物水平预测急性冠脉综合征PCI治疗后早期心血管事件的临床意义

Clinical significance of biomarker levels in predicting early cardiovascular events in patients with acute coronary syndrome after PCI therapy

目的探讨生物标志物水平在预测急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)治疗后早期心血管事件的临床意义。方法采用放射免疫分析、化学发光免疫分析和荧光免疫分析测定196例ACS患者,包括85例急性心肌梗死(AMI)和111例不稳定性心绞痛(UAP);56例稳定性心绞痛(SAP)和60例正常对照组血浆CTn I、HCY、NT-pro BNP和hs-CRP水平,并与正常对照组进行比较性分析。Pearson相关分析法,将CTn I、HCY、NT-pro BNP和hs-CRP分别与左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)进行双变量相关分析。采用受试者工作特征曲线(ROC曲线)分析CTn I、HCY、NTpro BNP和hs-CRP,预测发生心血管事件的临床意义。结果 196例ACS患者血浆CTn I、HCY、NT-pro BNP和hs-CRP水平较56例SAP和60例正常对照组明显增高,而且随ACS患者的疾病严重程度而增高。Pearson双变量相关分析表明,血浆CTn I、HCY、NT-pro BNP和hs-CRP与LVEDD呈正相关,与LVEF呈负相关。ROC曲线辨别了血浆CTn I、HCY、NT-pro BNP和hs-CRP水平的临界值(cut-off值)分别为0.42 ng/m L、28.43μmol/L、473.26 pg/m L和3.81 mg/L。预测心血管事件均有较高的灵敏度(分别为81.24%、65.11%、80.68%和52.34%)和特异度(分别为94.10%、73.51%、92.37%和62.69%)。结论生物标志物CTn I、HCY、NT-pro BNP和hs-CRP在评价ACS严重程度及预测心血管事件中有重要的临床意义。

Objective To explore the clinical significant of biomarkers levels predicting early cardiovascular events in patients with acute coronary syndrome（ ACS） after PCI therapy. Methods Radioimmunoassay,chemiluminescence immunoassay,and fluoroimmunoassay were used in 196 patients with ACS（ including 85 AMI cases and 111 UAP cases）. The plasma CTn I,HCY,NT-pro BNP and hs-CRP levels were determined in 56 SAP cases and 60 controls and were compared with the results of the normal control group. The bivariate correlation analysis was applied between CTn I,HCY,NT-pro BNP,hs-CRP and LVEF,LVEDD by Pearson relation analysis method. The receiveroperating characteristic curve（ ROC curve） was plotted to analyze the accuracy of plasma CTn I,HCY,NT-pro BNP and hs-CRP to predict the cardiovascular events. Results The plasma CTn I,HCY,NT-pro BNP and hs-CRP levels were significantly higher than those in 56 SAP cases and 60 controls and were increased with ACS severity. The peardon bivarate relation analysis showed that the plasma CTn I, HCY, NT- pro BNP, and hs- CRP were positively related with LVEDD,but were negatively related with LVEF. ROC curve revealed that the accuracy of plasma CTn I,HCY,NT-pro BNP and hs- CRP value in patients with ACS were 0. 4 2 ng / m L,28. 43 μmol / L,473. 26 pg / m L and 3. 81 mg / L respectively, the sensitivity was 81. 24%,65. 11%,80. 68% and 52. 34% respectively and specificity were 94. 10%,73. 51%,92. 37% and62. 69% respectively. Thus,the plasma CTn I and NT-pro BNP had high sensitivity and specificity.Conclusion The plasma CTn I,HCY,NT-pro BNP and hs-CRP levels are of great significance in evaluating ACS severity for cardiovascular events in clinics.