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|本期目录/Table of Contents|

髓过氧化物酶早期识别急性冠状动脉综合征的临床价值(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2012年第3期
页码:
370-373,384
栏目:
临床研究
出版日期:
2012-06-25

文章信息/Info

Title:
Clinical value of myeloperoxidase in early identification of acute coronary syndrome
作者:
马庆华1; 张 钲2; 刘兴荣3; 潘 明2; 申希平3; 邓爱云2; 白 明2
(兰州大学：1.第一医院医务科，2.第一医院心脏中心，3.公共卫生学院流行病与卫生统计学研究所，甘肃 兰州 730000)
Author(s):
MA Qing-hua1;  ZHANG Zheng2;  LIU Xing-rong3;  PAN Ming2;  SHEN Xi-ping3;  DENG Ai-yun2;  BAI Ming2
(1.Heart Center, First Hospital, 2.School of Public Health, Lanzhou University, Lanzhou 730000, Gansu, China)
关键词:
髓过氧化物酶; 急性冠状动脉综合征; 炎症标志物;  早期识别
Keywords:
myeloperoxidase;  acute coronary syndrome;  inflammatory marker;  early identification
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的:探讨髓过氧化物酶(MPO)浓度与急性冠状动脉综合征(ACS)的关系及其早期识别ACS的临床价值。方法： 采用酶联免疫吸附法测定血浆MPO浓度。 结果： ACS组患者血浆MPO浓度明显升高，与正常对照组、稳定型心绞痛（SAP）组比较差异有统计学意义（P<0.05）。SAP组血浆MPO浓度高于正常对照组（P<0.05）。血浆MPO浓度与中性粒细胞、肌酸激酶同工酶及受试组呈正相关，与年龄、高敏感C反应蛋白、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、三酰甘油、天冬氨酸氨基转移酶、空腹血糖、乳酸脱氢酶、红细胞计数、血小板计数无相关性。依据临床表现和冠状动脉造影，临床诊断ACS 41例, 非ACS组37例，绘制ROC曲线（A=0.927，P=0.000）。MPO诊断界值为212.59 μg/L，MPO≥212.59 μg/L为阳性，诊断为ACS，MPO<212.59 μg/L为阴性，诊断非ACS。临床诊断ACS 41例中，MPO阳性39例，阴性2例，非ACS组37例中，MPO阳性5例，阴性32例，MPO诊断ACS灵敏度为95%,特异度为86%，准确度为91%，假阴性率(漏诊率)为5%，假阳性率(误诊率)为14%，阳性预测值为89%，阴性预测值为94%。本法与临床诊断ACS方法进行Kappa一致性检验，Kappa系数值为0.819，P=0.000，说明两种方法的吻合程度具有统计学意义，两法一致性较好。采用Logistic逐步回归，筛选出有统计学意义的影响因素为MPO 、低密度脂蛋白胆固醇和肌酸激酶同工酶，建立预测模型，MPO预测ACS总正确率为95%，提示MPO对ACS具有较高的预测价值。结论： MPO能有效地早期识别ACS。
Abstract:
AIM:To explore the relationship between plasma concentrations of myeloperoxidase (MPO) and onset and progress of acute coronary syndrome (ACS) and the clinical value of MPO in the early identification of ACS. METHODS: MPO concentrations were measured by enzyme-linked immunosorbent assays (ELISA). RESULTS: Patients with ACS had significantly higher MPO concentrations than patients with stable angina pectoris (SAP) and control groups (P<0.05). Significant MPO differences were found between SAP patients and control groups (P<0.05). A positive correlation was observed between MPO and neutrophils as well as creatine kinase isoenzyme (CK-MB). MPO did not demonstrate a correlation with age, highly sensitive C-reactive protein (hs-CRP), white blood cell (WBC) count, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), aspartate aminotransferase (AST), fasting blood glucose (FBG), lactate dehydrogenase (LDH), red blood cell (RBC) count, and platelet count (PC). Forty-one patients in ACS group and 37 patients in the non-ACS group were diagnosed according to clinical manifestations and coronary angiography. The best cut-off point for MPO was identified as ≥212.59 μg/L using the ROC curve (A=0.927, P=0.000), revealing 39 patients with positive MPO in ACS when MPO was ≥212.59 μg/L and two patients with negative MPO in non-ACS group when MPO was <212.59 μg/L. Sensitivity, specificity and total consistent rate of MPO were, respectively, 95%, 86% and 91%. The false negative rate (the rate of misdiagnosis) was 5% and the false positive rate (misdiagnosis rate) was 14%. Positive and negative predictive values were 89% and 94%, respectively. Kappa value (0.819, P=0.000) showed that the two diagnostic methods were in good agreement. Logistic regression identified significant differences in MPO, LDL-C and CK-MB between ACS group and non-ACS group. A predictive model of ACS was established using these variables and the total correct rate of MPO in predicting ACS reached 94.9%. CONCLUSION: MPO is useful in the early identification of ACS.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2011-07-11.通讯作者：申希平，讲师，主要从事数据处理的计算机方法研究 Email:shenxp@Lzu.edu.cn 作者简介：马庆华，主治医师，硕士生 Email:heart2006cn@126.com
更新日期/Last Update: 2012-05-02