【摘要】 目的探讨妊娠相关血浆蛋白A(PAPP-A)在急性冠脉综合征(ACS)早期诊断中的价值。方法以82例临床诊断为ACS的患者为研究对象,其中急性心肌梗死(AMI)56例,不稳定型心绞痛(UAP)26例。另取20例稳定型心绞痛(SAP)和20例健康者为对照。测定血清PAPP-A、C反应蛋白(CRP)及ACS患者血清肌酸激酶同工酶(CK-MB)、肌钙蛋白T(TNT)水平。采用单因素方差分析方法比较各组间临床资料;应用秩和检验方法比较各组间PAPP-A和CRP水平;应用Spearman等级相关方法说明PAPP-A与CRP、CK-MB、TNT的相关程度,并计算ROC曲线下面积比较PAPP-A和CRP水平对ACS的早期诊断价值。结果ACS患者PAPP-A和CRP水平明显高于SAP组和对照组(P<0·01,P<0·001),UAP与AMI之间、SAP与对照组之间比较差异均无统计学意义(P>0·05)。ACS患者PAPP-A与CRP明显相关(r=0·898,P<0·01),与CK-MB及TNT无相关性。应用PAPP-A早期预测ACS患者的ROC曲线下面积为0·91,应用CRP早期预测ACS患者的ROC曲线下面积为0·78,PAPP-A相应的敏感性为88%,特异性为84%。结论PAPP-A可以反映冠状动脉粥样硬化斑块的不稳定性,对ACS有早期诊断价值,但不是心肌坏死的标志物。更多还原

【Abstract】 Objective To evaluate the value of pregnancy-associated plasma protein-A(PAPP-A) in the diagnosis of acute coronary syndrome(ACS).Methods To measure PAPP-A,C reactive protein in 56 patients with AMI,26 patients with UAP,20 patients with SAP and 20 controls.In the different groups,clinical data were compared with one-way ANOVA,PAPP-A and CRP were evaluated by Kruskal-Wallis test,correlation between PAPP-A and CRP,CK-MB,TNT were assessed by Spearman’s rank-correlation analysis,and early diagnostic value of PAPP-A and CRP for ACS were compared by calculating the area under the ROC curve.Results The median PAPP-A and CRP levels were significantly higher in AMI and UAP groups than in the control and SAP groups(P<0.01,P<0.001).There were no statistical significances in PAPP-A and CRP levels between UAP group and AMI group,between SAP group and control group(P>0.05).The level of CRP significantly associated with the PAPP-A level in the patients with ACS(r=0.898,P<0.01).There was no significant relationship between the levels of PAPP-A and TNT,CK-MB.The area under the ROC curve for PAPP-A was 0.91±0.08,for CRP was 0.78±0.05.Conclusion PAPP-A is a novel marker for the early diagnosis of ACS.PAPP-A levels associated with plaque stability and was predictive parameter for plaque stability,but it is not a marker for AMI.更多还原