首都医科大学学报 ›› 2007, Vol. 28 ›› Issue (4): 445-449.

• 专题报道 • 上一篇    下一篇

急性冠状动脉综合征与不稳定斑块的检测

何禹, 傅研   

  1. 首都医科大学附属北京同仁医院急诊科
  • 收稿日期:2007-06-12 修回日期:1900-01-01 出版日期:2007-08-24 发布日期:2007-08-24

Acute Coronary Syndrome and Detection of Unstable Plaque

He Yu, Fu Yan   

  1. Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University
  • Received:2007-06-12 Revised:1900-01-01 Online:2007-08-24 Published:2007-08-24

摘要:

目的 研究高敏C反应蛋白(hs-CRP)、血浆妊娠相关蛋白A(PAPP-A)、基质金属蛋白酶-9(MMP-9)在急性冠状动脉综合征(ACS)的诊断及评价短期预后中的价值。方法 选取ACS患者60例(分为不稳定心绞痛组(UA)35例和急性心肌梗死组(AM I)25例及健康对照组30例,检测血清hs-CRP及PAPP-A、MMP-9的水平,并对ACS患者进行30 d的随访。结果 对照组、不稳定心绞痛(UA)组、急性心肌梗死(AM I)组间hs-CRP、PAPP-A和MMP-9差异有统计学意义(P<0.01),其中hs-CRP任意2组间差异均有统计学意义(P<0.01;P<0.05);PAPP-A和MMP-9任意2组间差异均有统计学意义(P<0.01)。患者血清hs-CRP与PAPP-A、MMP-9水平有相关性。单变量分析显示随访30 d内发生主要不良心血管事件(MACE)的患者hs-CRP及PAPP-A、MMP-9水平高于未发生者(P<0.01),Logistic回归显示PAPP-A、MMP-9与ACS短期预后显著相关(P<0.05)。结论 hs-CRP及PAPP-A、MMP-9的水平可以反映斑块的不稳定性,是ACS的重要危险因素。炎症加重了斑块的不稳定性,从而参与了ACS的发生发展。PAPP-A、MMP-9可以作为ACS患者短期预后的独立危险因素。对于ACS的短期预后的评估,PAPP-A和MMP-9较hs-CRP有更大的应用前景。

关键词: 急性冠状动脉综合征, 血浆妊娠相关蛋白A, 高敏C反应蛋白, 基质金属蛋白酶9, 主要不良心血管事件

Abstract:

Objective The aim of the present study is to assess the value of hs-CRP,PAPP-A and MMP-9 in diagnosis and to evaluate the short-term prognosis of ACS.Methods Sixty patients with ACS and 30 patients without ACS were enrolled in this study.The hs-CRP PAPP-A MMP-9 levels were measured.Patients with ACS were followed up for 30 days after admission.The relation between these three factors and the 30 days prognosis were observed.Results Blood hs-CRP levels showed significant differences between control and unstable angina(UA) groups(P<0.05),control and acute myocardial infarction(AMI) groups)P<0.01),as well as UA and AMI groups(P<0.01).There were very significant differences in blood PAPP-A and MMP-9 levels(P<0.01).Blood hs-CRP was positively correlated with blood PAPP-A and MMP-9.Single factor analysis showed all the three levels were higher in MACE patients(P<0.01).Logistic regression analysis showed that blood PAPP-A and MMP-9 were correlated with MACE in 30 days(P<0.05).Conclusion Because the hs-CRP,PAPP-A and MMP-9 might decrease the stability of the plaque,they are important risk factors of ACS.Inflammation affected the development and changes of ACS by decreasing the stability of the plaque.The levels of hs-CRP PAPP-A and MMP-9 are correlated with the short-term prognosis of ACS.PAPP-A and MMP-9 levels are independent risk factors of short-term prognosis in ACS patients.PAPP-A and MMP-9 could be better predictors than hs-CRP.

Key words: acute coronary syndrome(ACS), pregnancy-associated plasma protein-A(PAPP-A), high-sensitivity Creactive protein(hs-CRP), matrix metalloproteinase-9(MMP-9), main adverse cardiovascular event(MACE)

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