摘要
目的:探讨髓过氧化物酶(MPO)、心型脂肪酸结合蛋白(H-FABO)检测对非ST段抬高急性冠状动脉综合征(NSTE-ACS)危险分层的价值。方法:将2012-07-2015-07收治的247例NSTE-ACS患者作为NSTE-ACS组,同期在医院体检的健康人群75例作为对照组,NSTE-ACS患者分为NSTEMI组164例和UA组83例,按照冠状动脉狭窄程度分为轻度狭窄组113例、中度狭窄组55例和重度狭窄组79例,按照冠状动脉病变受累程度分为单支病变组85例、双支病变组69例和三支病变组93例,按照GRACE评分分为低危组118例、中危组92例和高危组37例;采用双抗体夹心法酶联免疫吸附试验检测各组血清H-FABO含量,酶联免疫吸附试验检测血清MPO、高敏C反应蛋白(hs-CRP)含量;NSTE-ACS患者随访12个月,记录6个月、12个月主要心脏不良事件(MACE)发生情况,通过绘制ROC曲线分析血清H-FABO、MPO对NSTE-ACS发生MACE的预测价值。结果:各组间性别、年龄比较差异无统计学意义(P>0.05),NSTE-ACS组血清H-FABO、MPO、hs-CRP均显著高于对照组(P<0.05),NSTEMI组血清H-FABO、MPO、hs-CRP显著高于UA组(P<0.05)。随着冠状动脉狭窄程度加重,血清H-FABO、MPO、hs-CRP逐渐升高,其中中度狭窄组、重度狭窄组血清H-FABO、MPO、hsCRP显著高于轻度狭窄组,重度狭窄组血清H-FABO、MPO、hs-CRP又显著高于中度狭窄组(P<0.05);随着冠状动脉病变受累程度加重,血清H-FABO、MPO、hs-CRP逐渐升高,其中双支病变组、三支病变组血清H-FABO、MPO、hs-CRP显著高于单支病变组,三支病变组血清H-FABO、MPO、hs-CRP又显著高于双支病变组(P<0.05);随着危险度级别升高,血清H-FABO、MPO、hs-CRP逐渐升高,中危组、高危组血清H-FABO、MPO、hsCRP显著高于低危组,高危组血清H-FABO、MPO、hs-CRP又显著高于中危组(P<0.05)。H-FABO预测6个月发生MACE的AUC为0.809,MPO预测6个月发生MACE的AUC为0.794,2种指标预测6个月发生MACE的AUC差异无统计学意义(Z=0.974,P=0.651);H-FABO预测12个月发生MACE的AUC为0.786,MPO预测12个月发生MACE的AUC为0.869,MPO预测12个月发生MACE的AUC显著高于H-FABO(Z=2.843,P=0.017)。结论:随着动脉狭窄程度加重、病变支数增多、危险度级别升高,血清H-FABO、MPO逐渐升高;H-FABO、MPO对近期发生MACE均具有良好的预测价值,MPO对远期发生MACE具有良好的预测价值。
Objective：To explore the risk stratification value of heart-type fatty acid-binding protein（H-FABO） and myeloperoxidase（MPO） detection in non-ST-segment elevation acute coronary syndrome （NSTE-ACS）. Meth- od： A total of 247 cases of NSTE-ACS paitients treated in hospital from July 2012 to July 2015 were selected as NSTE-ACS group, and 75 cases of healthy people done physical examination in hospital at same period were se- lected as control group. NSTE-ACS patients were divided into NSTEMI group 164 cases and UA group 83 cases. According to the degree of coronary artery stenosis, NSTE-ACS patients were divided into mild stenosis group 113 cases, moderate stenosis group 55 cases and severe stenosis group 79 cases. According to the degree of coronary artery lesion involvement, NSTE-ACS patients were divided into single vessel disease group 85 cases, double ves- sel disease group 69 cases and three vessel disease group 93 cases. According to the GRACE score, NSTE-ACS patients were divided into low risk group 118 cases , middle risk group 92 cases and high risk group 37 cases. SerumH-FABO was detected by sandwich enzyme-linked immunosorbent assay, serum MPO and hs-CRP were detected by enzyme linked immunosorbent assay. NSTE-ACS patients were followed up for 12 months, and the incidence of major adverse cardiac events （MACE） at 6 months and 12 months were recorded, the predictive value of H-FABO and MPO on MACE was analyzed by ROC curve. Result： There was no significant difference in gender and age be- tween each groups （P〉0.05）, the serum H-FABO, MPO and hs-CRP in NSTE-ACS group were significantly higher than those in control group （P〈0.05）, serum H-FABO, MPO and hs-CRP in NSTEM1 group were signif- icantly highe than those in NSTEMI group（P〈0.05）. With the severity of coronary artery stenosis increased, se- rum H-FABO, MPO and hs-CRP were gradually increased, the serum levels of H-FABO, MPO and hs-CRP in moderate stenosis group and severe stenosis group were significantly higher than those in the mild stenosis group, H-FABO, MPO and hs-CRP in severe stenosis group were significantly higher than those in the moderate stenosis group （P〈0.05）. With the severity of coronary artery lesions increased, serum H-FABO, MPO and hs-CRP gradually increased, the serum levels of H-FABO, MPO and hs-CRP in double vessel disease group and three ves- sel disease group were significantly higher than those in single vessel disease group, serum H-FABO, MPO and hs-CRP in three vessel disease group were significantly higher than those in double vessel disease group （P〈0.05）. With risk level increased, serum MPO, H-FABO and hs-CRP gradually increased, the serum H-FABO, MPO and hs-CRP in middle risk group and high risk group were significantly higher than those in the low risk group, serum H-FABO, MPO and hs-CRP in high risk group were significantly higher than those in middle risk group （P〈0.05）. AUC of H-FABO and MPO prediction of 6 months MACE occurrence was 0. 809 and 0. 794, respectively. There were no significant difference between AUC of these two indicators （Z = 0. 974, P = 0. 651）. AUC of H-FABO and MPO prediction of 12 months MACE occurrence was 0. 786 and 0. 869, respectively. AUC of MPO prediction of 12 months MACE occurrence was significantly higher than that of H-FABO （Z=2. 843 ,P= 0. 017）. Conclusion： With the degree of arterial stenosis aggravated, disease vessels number increased, risk level increased, serum H-FABO and MPO gradually increased. MPO and H-FABO might have good predictive value for the recent occurrence of MACE, and MPO might has a good predictive value for the long-term occurrence of MACE.
出处
《临床血液学杂志（输血与检验）》
CAS
2017年第1期93-98,共6页
Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)
