髓过氧化物酶早期识别急性冠状动脉综合征与临床价值.docVIP

髓过氧化物酶早期识别急性冠状动脉 综合征的临床价值 马庆华1，张钲1，刘兴荣2，潘明1，申希平1，邓爱云1﹡，白明1，周荣1，王志禄1 (1.兰州大学第一医院；2.兰州大学公共卫生学院，甘肃 兰州 730000) 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)发生、发展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 1.ACS组患者血浆MPO浓度明显升高，与Control组、SAP组比较差异有统计学意义（P0.05）。2.SAP组血浆MPO浓度高于Control组（P0.05）。3.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、甘油三脂、天冬氨酸氨基转移酶、空腹血糖、、4.依据临床表现和冠脉造影，临床诊断ACS 41例, 非ACS组37例，绘制ROC曲线（A=0.927，P =0.000MPO≥212.59 ng/ml为阳性，诊断为ACS，MPO212.59 ng/ml为阴性，诊断非ACS。临床诊断ACS 41例中，MPOMPO阳性32例，阴性5例，MPO诊断ACS灵敏度为95.1%,特异度为86.5%，总符合率91.0%，假阴性率(漏诊率)为4.9%，假阳性率(误诊率)为13.5%，阳性预测值为88.6%，阴性预测值为94.1%。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 = 0.0005.采用Logistic 逐步回归，筛选出有统计学意义的影响因素为MPO 、MPO预测ACS总正确率为94.9%，提示MPO对ACS具有较高的预测价值。结论 MPO是一种预测ACS的炎症标志物，MPO诊断ACS准确度较高。 关键词：髓过氧化物酶;急性冠状动脉综合征;炎症标志物 中图分类号：R541.4 文献标识码：A 文章编号： Early identification and clinical Value of Myeloperoxidase in Acute Coronary Syndrome MA Qing-hua1, ZhANG Zheng1, LIU Xing-rong2, PAN Ming1, SHEN Xi-ping2, DENG Ai-yun1﹡，BAI MingZHOU Rong1, WANG Zhi-lu1 (1.Department of Cardiology, the First Hospital of Lanzhou University, 2.School of Public Health of Lanzhou University, Lanzhou 730000, China) Abstract: Objective To research the relationship between the plasma concentrations of MPO and the onset and progress of acute coronary syndrome (ACS) and early identification and clinical value of MPO in ACS. Methods MPO concentrations were measured by enzyme-linked immunosorbent assays (ELISA). Results 1.Patients with ACS had significantly raised MPO concentrations when compared with patients with SAP and Control groups ( P0.05 ). 2.There were significant differences of MPO between SAP and Control groups ( P0.05 ). 3.A positive correlation was observed between MPO and Neutrophils, CK-MB, subject groups. MPO did not correlate with Age, hs-CRP, WBC, TC, LDL-C, HDL-C, TG, AST, FBG, LDH, RBC, PC. 4.41 patients in ACS and 37 patients in non-ACS group were diagnosed according to clinical