血清H-FABP和MPO检测对老年NSTE ACS患者早期诊断及危险分层价值的研究

doi:10.3969/j.issn.1673-8640.2013.04.004

摘要/Abstract

摘要： 目的　探讨血清心型脂肪酸结合蛋白（H-FABP）和髓过氧化物酶（MPO）对老年非ST段抬高急性冠状动脉综合征（NSTE ACS）患者早期诊断及危险分层的意义。方法　将107例NSTE ACS患者按病情严重程度分为不稳定型心绞痛（UAP）组（38例）和非ST段抬高性心肌梗死(NSTEMI)组（69例）；按冠状动脉狭窄程度将其分为轻度组（49例）、中度组（24例）和重度组（34例）；按冠状动脉病变受累范围分为单支组（37例）、双支组（30例）和三支组（40例）；按全球急性冠状动脉事件注册(GRACE)风险评分分为低危组（51例）、中危组（40例）和高危组（16例）。采用双向侧流免疫法检测107例NSTE ACS患者及31名健康对照者血清H-FABP、心肌肌钙蛋白I（cTnI）浓度，采用酶联免疫吸附试验测定血清MPO浓度，采用胶乳增强免疫比浊法测定高敏C反应蛋白（hs-CRP）。结果　NSTEMI组血清H-FABP、MPO、cTnI、hs-CRP浓度明显高于UAP组及正常对照组(P＜0.05)，且UAP组明显高于正常对照组(P＜0.05)。NSTE ACS患者血清H-FABP、MPO及hs-CRP浓度与冠状动脉狭窄程度、病变支数及GRACE风险评分密切相关，随患者冠状动脉狭窄程度、冠状动脉病变支数及GRACE风险评分的增加，其血清H-FABP及MPO浓度逐渐增高，不同狭窄程度组、不同病变支数组和不同危险层次组组间差异有统计学意义(P均<0.01)，且均明显高于对照组(P＜0.01)。NSTE ACS患者血清H-FABP与MPO、hs-CRP呈正相关(r值分别为0.555 0、0.526 0，P＜0.01)。结论　NSTE ACS患者血清H-FABP、MPO浓度与冠状动脉狭窄程度、病变支数及患者危险级别密切相关，对NSTE ACS患者的早期诊断和危险分层有一定意义。

关键词: 心型脂肪酸结合蛋白, 髓过氧化物酶, 非ST段抬高的急性冠状动脉综合征

Abstract: Objective　To investigate the early diagnosis and risk stratification significance of the determination for serum heart-type fatty acid-binding protein (H-FABP) and myeloperoxidase (MPO) in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS). Methods　The 107 patients with NSTE ACS were classified into 2 groups according to the severity of patient′s condition，unstable angina pectoris (UAP) group (38 cases) and non-ST-segment elevation myocardial infarction (NSTEMI) group (69 cases). According to the coronary narrow degree, they were classified into mild narrow group (49 cases)，moderate narrow group (24 cases) and severe narrow group (34 cases). The 107 patients were classified into 3 groups: single-vessel disease group (37 cases)，double-vessel disease group (30 cases) and multi-vessel disease group (40 cases) according to the coronary lesion involving range. The 107 patients were classified into 3 groups： low risk group (51 cases)，average risk group (40 cases) and high risk group (16 cases) according to the global registry of acute coronary event (GRACE) risk score. The levels of serum H-FABP and cardiac troponin I (cTnI) in the 107 patients with NSTE ACS and 31 healthy controls were detected by bidirectional lateral flow immunoassay, and the levels of serum MPO were detected by enzyme-linked immunosorbent assay. The high sensitive C reaction protein (hs-CRP) was determined by latex enhanced immuno-trubidimetry. Results　The levels of serum H-FABP，MPO, cTnI and hs-CRP in NSTEMI group were significantly higher than those in UAP group and the healthy control group (P＜ 0.05), and the levels in UAP group were significantly higher than those in the healthy control group (P＜0.05). In the NSTE ACS group, the levels of serum H-FABP and MPO had close relations with the coronary narrow degree，the coronary lesion involving range and GRACE risk score. The higher the levels of serum H-FABP, MPO and hs-CRP in the NSTE ACS group were，the higher the coronary narrow degree，the coronary lesion involving range and GRACE risk score were. The serum H-FABP, MPO and hs-CRP levels had statistical significance between the groups (P＜0.01), and the levels of H-FABP, MPO and hs-CRP in the coronary narrow degree, the coronary lesion involving range and GRACE risk score groups were higher than those in the healthy control group (P＜0.01). There was a positive correlation of H-FABP with MPO and hs-CRP in the NSTE ACS patients (r=0.555 0 and 0.526 0，P＜0.01). Conclusions　The H-FABP and MPO levels are the biomarkers in NSTE ACS patients. The levels of serum H-FABP and MPO in the NSTE ACS patients have close relations with the coronary narrow degree，the coronary lesion involving range and GRACE risk score. The H-FABP and MPO have the early diagnosis and risk stratification significance in elderly patients with NSTE ACS.

Key words: Heart-type fatty acid-binding protein, Myeloperoxidase, Non-ST-segment elevation acute coronary syndrome

陈键. 血清H-FABP和MPO检测对老年NSTE ACS患者早期诊断及危险分层价值的研究[J]. 检验医学, 2013, 28(4): 271-275.

CHEN Jian. Research on the early diagnosis and risk stratification significance of the determination for serum H-FABP and MPO in elderly patients with NSTE ACS[J]. , 2013, 28(4): 271-275.

参考文献

[1]Abbas AE，Boura JA，Brewington SD，et al.Acute angiographic analysis of non-ST-segment elevation acute myocardial infarction[J]. Am J Cardiol，2004，94 (7)：907-909.
[2]Azzazy HM，Pelsers MM，Christenson RH, et al. Unbound free fatty acids and heart-type fatty acid-binding protein： diagnostic assays and clinical applications[J]．Clin Chem，2006，52(1)：19-29．
[3]Ndrepepa G，Braun S，Mehilli J，et al. Myeloper-oxidase level in patients with stable coronary artery disease and acute coronary syndromes[J]. Eur J Clin Invest，2008，38(2)：90-96.
[4]Elbarouni B，Goodman SG，Yan RT，et. al.Validation of the global registry of acute coronary event （GRACE） risk score for in-hospital mortality in patients with acute coronary syndrome in Canada[J].Am Heart J，2009，158（3）：392-399．
[5]McCann CJ，Glover BM，Menown IB，et al．Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T[J]．Eur Heart J，2008，29(23)：2843-2850.
[6]Valle HA，Riesgo LG，Bel MS，et al．Clinical assessment of heart-type fatty acid binding protein in early diagnosis of acute coronary syndrome[J]. Eur J Emerg Med，2008，15(3)：140-144.
[7]林炜炜，邵康，徐晓萍，等. 髓过氧化物酶、高敏C反应蛋白等在冠心病严重程度评估中的应用[J].检验医学，2010，26(8)：551-554.
[8]梅拥军，林萍. 髓过氧化物酶与急性冠状动脉综合征的相关性探讨[J]. 江西医药，2010，45(2)：135 -138.
[9]金星，崔兰，金基永，等. 急性心肌梗死病人血清髓过氧化物酶和白细胞介素 6水平与冠状动脉病变程度的相关性 [J]. 延边大学医学学报，2010，33(2)：125-127.
[10]朴星杰，崔兰，宋京郁，等. 血清髓过氧化物酶与急性冠状动脉综合征的相关性[J].延边大学医学学报，2010，33(2)：128-130.

[1]	伊学军, 张爱玲, 翟建新. 冠状动脉慢血流性心绞痛患者血清胱抑素C及髓过氧化物酶水平的变化及其相关性[J]. 检验医学, 2018, 33(3): 191-195.
[2]	谭立明, 焦安君, 冯晓晶, 徐镠粤, 谭福燕, 何思齐, 罗姮, 陈娟娟, 蒋永清, 李华. 抗中性粒细胞胞浆抗体检测对系统性血管炎的临床价值[J]. 检验医学, 2018, 33(2): 101-105.
[3]	薄磊, 单既刚, 赵志文. 心血管疾病中髓过氧化物酶的研究进展[J]. 检验医学, 2017, 32(8): 738-743.
[4]	徐庆雷, 周红, 马小波, 张巍, 刘玲玲, 刘刚, 张敏. 哮喘患儿支气管肺泡灌洗液GM-CSF和MPO水平的变化及意义[J]. 检验医学, 2017, 32(7): 603-606.
[5]	伍树芝，邓胜，秦伟国，陈健，易斌. 联合检测NT-proBNP、H-FABP和cTnI对老年重症心力衰竭患者的临床价值[J]. 检验医学, 2014, 29(4): 312-318.
[6]	邹国英，任碧琼. 颅脑损伤患者早期缺血修饰白蛋白的检测[J]. 检验医学, 2013, 28(2): 93-96.
[7]	马庆华 1，邓爱云 1，张钲 1，刘兴荣 2，潘明 1，申希平 1，白明 1，王志禄 1. 髓过氧化物酶对胸痛患者的临床意义[J]. 检验医学, 2013, 28(1): 25-29.
[8]	江明凤. 心型脂肪酸结合蛋白在急性心肌梗死早期诊断中的意义[J]. 检验医学, 2012, 27(6): 511-513.
[9]	韩海荣;梁颖;赵卫国;沈茜. 髓过氧化物酶双抗体夹心光激化学发光检测法的建立[J]. 检验医学, 2012, 27(4): 291-295.
[10]	林炜炜;邵康;徐晓萍;于嘉屏. 髓过氧化物酶、高敏C反应蛋白等在冠心病严重程度评估中的应用[J]. 检验医学, 2011, 26(08): 551-554.
[11]	宋斌斌;赵瀛;张春燕;吴炯;郭玮;潘柏申. 两种抗中性粒细胞胞浆抗体检测方法的结果比较[J]. 检验医学, 2011, 26(07): 457-460.
[12]	高红;周晶萍;袁文;王象勇. 健康人群从平原进入高原心型脂肪酸结合蛋白的变化[J]. 检验医学, 2011, 26(07): 484-485.
[13]	丁柳美;唐钧;倪培华. 心型脂肪酸结合蛋白在诊断急性心肌梗死中的临床意义[J]. 检验医学, 2011, 26(06): 383-386.
[14]	伍树芝;鲁晓红;谭逵;陈健. 血清H-FABP检测对AMI患者诊断及预后和死亡风险评估的价值研究[J]. 检验医学, 2011, 26(04): 249-251.
[15]	丁天凌;朱萍;吴蓓倩;陈字;许小平;谢毅. 流式细胞仪检测白细胞胞浆内抗原髓过氧化物酶的实验研究及其应用[J]. 检验医学, 2007, 22(06): 651-655.