纤维蛋白原、内皮素、P-选择素及肌钙蛋白Ⅰ测定在急性冠脉综合征诊断中的价值

The value of fibrinogen. endothelin - 1, P - selection and troponin I in diagnosis of acute coronary artery syndrome

目的 判断纤维蛋白原(Fg)、内皮素(ET-1)、P-选择素和肌钙蛋白Ⅰ(cTnI)对急性心肌梗死(AMI)和不稳定型心绞痛(UA)的诊断价值。方法 用Beckmun全自动生化仪测定Fg,放射免疫法测定ET-1,流式细胞术测定P-选择素,Access化学发光法测定cTnI,共测定23例AMI患者,21例UA患者和28例健康对照者。结果 3组被检者的Fg、ET-1、P-选择素及cTnI的含量均值间差别均有非常显著性意义(P<0.01);UA组与AMI组患者的P选择素、cTnI的含量间差别有显著性意义(P<0.05),而Fg、ET-1的含量间差别无显著性意义(P>0.05);AMI组与对照组被检者的Fg、ET-1、P-选择素,cTnI的含量间差别均有显著性意义(P<0.05);UA组与对照组被检者的Fg、ET-1、P-选择素的含量间差别亦有显著性意义(P<0.05),而cTnI含量间差别无显著性意义(P>0.05)。多元回归分析发现P-选择素与cTnI含量间存在一定的相关关系(r=0.404,P<0.01)。判断分析发现同时测定Fg、ET-1、P-选择素及cTnI可预测患者属于AMI、UA和对照组的正确性为86.7％。结论 Fg、ET-1、P-选择素是检测血栓前状态的敏感指标,Fg、ET-1、P-选择素和cTnI同时测定可预测急性冠脉综合征的发生。

Objective To study the relationship among fibrinogen, P-selection, troponin I and endothelin - 1 with acute myocardial infarction (AMI) and unstable angina (UA). Methods Plasma level of fibrinogen was analyzed by Beck-mun's Autobiochemical Instrument. Plasma level of endthelin - 1 was analyzed by radioimmunoassay, the expression of P - selection by flow cytometry technique and troponin I by paramagnetic - partile chemiluminescent immunoassay in 23 cases with AMI, 21 eases with UA and 28 healthy controls. Results Plasma levels of fibrinogen, endothelin - 1 , and thoponin I were significantly higher in patients with AMI than those in controls ( P <0. 05 ). The expression of P - selection was significantly higher in patients AMI than that in controls ( P <0. 005) ; Plasma levels of fibrinogen and expression of P - selection were significantly higher in patients with UA than those in controls ( P <0. 05). There was an increased trend of troponin Iin patients with UA in contrast to controls, but without statistical significance ( P >0. 05). As compared with UA, plasma levels of tropomin Iand expression of P - selection were significantly elevated in patients with AMI ( P <0. 05) , no significant difference was observed between AMI and UA in Plasma levels of fibrinogen and endothelin - 1 ( P >0. 05). Multivariate regression analysis revealed that expression of P - selection was a significant variable associated with AMI and UA compared with plasma levels of troponin I ( r = 0. 404 , P < 0. 01 ). Diseriminent analysis showed that unied detection of fibrinogen, endothelin - 1 , P - selection and troponin I may forecasted AMI and UA (specificity 86. 7% ). Conclusion Plasma levels of fibrinogen, endothelin - ! and troponin I and expression of P - selection were sensitive markers as premobolic status. The analysis of them at the same lime can calculate the happen of acute coronary artery syndrome.