前列腺特异性抗原异构体在急性心肌梗死的临床应用

目的观察急性心肌梗死患者血清前列腺特异性抗原异构体（p2PSA）变化规律，探讨p2PSA在急性心肌梗死的临床应用价值。方法急性心肌梗死患者56例（AMI组），非急性心肌梗死疾病患者60例（非AMI组），分别在就诊即刻（Oh）、2h、12h、24h测定血清p2PSA、cTnI、CK-MB水平。比较p2PSA、cTnI、CK-MB在急性心肌梗死时的变化规律与升高倍数。结果Oh时AMI组与非bAMI组血清p2PSA水平均升高，AMI纽升高率82％（46／56），均值（2．22±1．90）ng／L，非bAMI纽升高率为26％（16／60），均值（3．19±2．79）ng／L。随着时间的推移，AMI组血清p2PSA水平与时间呈正相关，24h仍高于参考范围上限，差异有统计学意义（P〈0．05）。在0h时p2PSA即升高而CTnI、CK．MB未见升高；2h时三种指标均升高，p2PSA升高倍数为参考范围上限（2．22±0.7）倍，比另外两标志物高；p2PSA在12h达峰值，为参考范围上限（5．1±0．6）倍；CTnI峰值也在12h，为参考范围上限（40．6±0．2）倍；CK-MB峰值出现在24h，为参考范围上限（5．1±0．2）倍。结论p2PSA是一种心肌损伤标志物，在心肌损伤早期升高，p2PSA、CTnI和CK．MB三者联合检测有利于提高急性心肌梗死的早期诊断、疗效判断及再梗死判断。

Objective To observe the level of prostate-specific antigen isoforms p2PSA after actue myocardial infarction （ AMI ） and to evaluate clinical use of p2PSA in diagnosis of AMI. Methods Serum cTnI, CK-MB and p2PSA were assessed in 56 patients with AMI and 60 patients without AMI but suspected AMI admitted to the emergency department of Zhejiang provincial hospital of TCM. Blood was collected at admission （ Oh ） , 2, 8, 12 and 24h. Levels and relationships between p2PSA, cTnI and CK-MB were analyzed. Results p2PSA values increased in 46/56 （ 80% ） AMI patients （ 2.22 ± 1.90pg/ml ） , as compared with 16/60 （ 26% ） in those without AMI （ 3.19 ±2.79 pg/ml ） at Oh. Over time, serum p2PSA levels in patients with AMI were positively correlated with time, which were beyond the reference value at 24h （ P〈0.05 ） . p2PSA levels increased in patients with AMI at admission （ Oh ） while eTnI and CK-MB were still below the upper limit of reference values, and it reached the peak values at 12h. Conclusion p2PSA is a marker after acute myocardial infarction that increased during the early period of myocardial injury. Combined use of p2PSA, cTnI and CK-MB help improve the early diagnosis, therapeutic effects of AMI and myocardial infarction by reperfusion.