【摘要】 目的 探讨血清髓过氧化物酶(MPO)水平在急性冠脉综合征(ACS)诊断特别是鉴别诊断中的价值。方法 将病例分为4组:①ACS组71例(不稳定型心绞痛20例、急性ST段抬高型心肌梗死46例、急性非ST抬高型心肌梗死5例);②稳定型心绞痛(SAP)组30例;③体检对照组54例;④非ACS胸痛组29例(主动脉夹层6例、心律失常5例、呼吸道感染4例、冠状动脉肌桥2例、肋间神经痛2例、心脏神经功能紊乱2例、消化性溃疡2例、病毒性心肌炎1例、扩心病1例、肺栓塞1例、胸腺增生1例、胸膜炎1例、肋骨骨折1例)。通过酶联免疫法(ELISA)测量血清MPO的含量进行组间比较,并与目前常用的心肌损伤标志物心脏型脂肪酸结合蛋白(H-FABP)、肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)进行特异性和敏感性对比。结果 ①ACS组患者血清MPO水平明显升高,与SAP组、体检对照组比较差异均有统计学意义(P<0.01)。②ACS组内不稳定型心绞痛(UA)与急性心肌梗死(AMI)比较血清MPO水平差异无统计学意义(P>0.05),与心肌损伤标志物比较,MPO诊断UA的特异性和敏感性不高(ROC曲线下面积仅为0.481),但优于心肌损伤标志物。③ACS组与非ACS胸痛组相比,血清MPO水平差异无统计学意义。绘制ROC曲线,MPO诊断ACS的曲线下面积(AUC)为0.501,95%可信区间0.371~0.631,其鉴别诊断效能低于H-FABP、cTnI、CK-MB和MYO。结论 髓过氧化物酶作为生物标记物对诊断和鉴别诊断ACS价值有限:对既往有冠心病史的患者有一定的预警意义,能鉴别不稳定型心绞痛和稳定型心绞痛;对体检人员筛查潜在ACS风险有一定意义;在急诊鉴别胸痛患者是否为ACS(无论是UA还是AMI)无鉴别诊断价值。更多还原

【Abstract】 Objective To explore the serum myeloperoxidase value in diagnosis especially in differential diagnosis of acute coronary syndrome(ACS).Methods The subjects were divided into four groups:ACS(n =71)group[including 20 patients of unstable angina pectoris(UA),46 patients of acute ST-elevation myocardial infarction(STEMI) and 5 patients of acute non-ST elevation myocardial infarction(NSTEMI)],stable angina pectoris(SAP)group(n=20),physical examination group(n=54),and not ACS chest pain group(n=29)(including 6 patients with aortic dissection,5 with arrhythmia,4 with respiratory tract infection,2 with myocardial bridge,2 with intercostal neuralgia,2 with cardioneurosis,2 with peptic ulcer,1 with pulmonary embolism,1 with viral myocarditis,1 with dilated cardiomyopathy,1 with pleural adhesions,1 with fractured ribs,1 with thymus hyperplasia).The serum concentration of MPO were measured by Enzyme-linked immunosorbent assays(ELISA) in each groups,and the cardiac damage markers including heart type fatty acid binding protein(H-FABP),troponin I(TNI),creatine kinase isoenzyme(CK-MB),myoglobin(MYO) were measured.The specificity and sensitivity of above parameters for the diagnosis of ACS were compared.Results(l)Patients with ACS had significantly higher MPO concentration than that of patients with stable angina pectoris(SAP)and control groups(P<0.01).(2)The level of MPO had no statistical significance between the UA and AMI in ACS group(P>0.05).Compared with myocardial injury markers,the specificity and sensitivity of MPO in the diagnosis of UA was not high(The area under the receiver operating characteristic(ROC) curve was 0.481),but better than that of myocardial injury markers.(3)The level of MPO had no statistical significance between the ACS group and not ACS chest pain group.For ACS,the area under the receiver operating characteristic curve was 0.501,95%confidence index is 0.371-0.631.Its differential diagnosis was lower than the H-FABP,TNI,CK-MB,MYO.Conclusion MPO is limited in diagnostic value and differential diagnosis of ACS.The level of serum myeloperoxidase may use to alert patients with coronary heart disease(CHD) history and identify stable angina pectoris and unstable angina pectoris,and has significance to screen potential risk of acute coronary syndrome.But there is no differential diagnosis value for ACS in the emergency department.更多还原