急性心肌梗死患者血清前白蛋白与炎症反应的关系

Relationship between serum prealbumin and inflammation in patients with acute myocardial infarction

目的探讨急性心肌梗死（AMI）患者血清前白蛋白（PA）水平及与炎症反应的关系。方法采用前瞻性观察性研究方法，选择2014年6月至2016年6月武警总医院心内科收治的AMI住院患者为研究对象，以同期健康体检者作为健康对照组。患者于入院时取肘静脉血，用免疫透射比浊法测定血清PA；用乳胶增强免疫比浊法检测超敏C-反应蛋白（hs-CRP）；用电化学发光法测定超敏心肌肌钙蛋白T（hs-cTnT）、白细胞介素（IL-6、IL-8）；用速率法测定肌酸激酶同工酶（CK-MB）。比较两组血清PA、炎性因子、心肌酶指标的差异；采用Pearson直线相关分析血清PA与各指标的相关性；绘制受试者工作特征曲线（ROC），分析PA对AMI的诊断价值。结果共入选173例AMI患者、86例健康对照者，两组性别、年龄及吸烟、高血压、糖尿病等既往史比较差异均无统计学意义（均P〉0．05），说明两组基线资料均衡可比。与健康对照组比较，AMI组PA显著下降[PA（g／L）：0．215±0．056比0．280±0．057]，hs-CRP、IL-6、IL-8、hs-cTnT、CK-MB均明显升高[hs-CRP（mg／L）：6．63±3．52比2．25±1．45，IL-6（ng／L）：38．03±22．43比6．13±3．38，IL-8（ng／L）：295．61±98．70比17．24±7．31，hs-cTnT（μg／L）：4．789±2．874比0．009±0．008，CK-MB（U／L）：244．48±165．54比12．20±5．24，均P〈0．01]。Pe-on相关分析显示，AMI患者PA与hs-CRP、IL-6、IL-8均呈显著负相关（r值分别为-0．562、-0．591、-0．548，均P〈0．05），与hs-cTnT、CK-MB无相关性（r值分别为-0．018、-0．149，均P〉0．05）。ROC曲线分析显示，血清PA水平诊断AMI的ROC曲线下面积（AUC）为0．783±0．039，95％可信区间（95％CI）为0．706-0．860（P〈0．05），PA截断值为0．190g／L时，诊断AMI的敏感度为29．63％，特异度为62．22％。结论PA可能参与AMI患者炎症反应过程，对AMI具有-定的诊断价值。

Objective To investigate the relationship between serum prealbumin （PA） and inflammation in acute myocardial infarction （AMI） patients. Methods A prospective observational study was conducted. AMI patients hospitalized in the cardiovascular department of the General Hospital of Chinese People＇s Armed Police Forces from June 2014 to June 2016 were enrolled in the study. At the same time, healthy cases were enrolled as control. Venous blood was taken fi＇om patients at admission. Serum PA was detected by immune projection turbidimetry method and high-sensitivity C-reactive protein （hs-CRP） was measured by latex enhanced immune turbidimetry. High-sensitivity cardiac troponin T （hs-eTnT）, and interleukin （IL-6, IL-8） was measured by electrochemical luminescence method. Creatine kinase-MB isoenzyme （CK-MB） was detected by rate method. PA, inflammatory factor and myocardial enzyme were compared between two groups. The correlation between PA and inflammatory factors was analyzed by Pearson linear correlation; The diagnostic value of PA was analyzed by receiver operating characteristic （ROC） curve. Results 173 AMI patients and 86 healthy controls were enrolled in the study. There were no significant differences in gender, age, history of smoking, hypertension and diabetes. Compared with the control, the levels of serum PA in AMI patients was lower [PA （g/L）： 0.215±0.056 vs. 0.280±0.057], hs-CRP, IL-6, IL-8, hs-cTnT and CK-MB were higher [hs-CRP （mg/L）： 6.63 ± 3.52 vs. 2.25 ± 1.45, IL-6 （ng/L）： 38.03 ± 22.43 vs. 6.13 ± 3.38, IL-8 （ng/L）： 295.61 ± 98.70 vs. 17.24 ± 7.31, hs-cTnT （μg/L）： 4.789 ± 2.874 vs. 0.009 ± 0.008, CK-MB （U/L）： 244.48 ± 165.54 vs. 12.20 ± 5.24], the difference was statistical significant （all P 〈 0.01）. It was shown by Pearson correlation analysis that the levels ofPA were negatively related to hs-CRP, IL-6 and IL-8 （r=-0.562, -0.591, -0.548, all P 〈0.05）. The PA level had no correlation with hs-cTnT and CK-MB （r = -0.018, -0.149, both P 〉 0.05）. It was shown by ROC curve analysis that area under ROC curve （AUC） of PA for diagnosis of AMI was 0.783 ± 0.039, and the 95% confidence interval （95%CI） was 0.706-0.860 （P 〈 0.05）. When the cut-off value was 0.190 g/L, the sensitivity was 29.63%, and the specificity was 62.22%. Conclusion PA may be involved in the inflammatory process of AMI and had a diagnostic value for AMI.