血清PN、MPO和hs-cTnT预测急性心肌梗死患者心血管不良事件的临床价值

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英文篇名：Clinical value of serum PN, MPO and hs-cTnT in predicting cardiovascular adverse events in patients with acute myocardial infarction 作者：徐高峰 ; 陈康 英文作者：XU Gaofeng;CHEN Kang;Department of Emergency,Shanghai Fengxian District Central Hospital; 关键词：急性心肌梗死 ; 骨膜蛋白 ; 人髓过氧化物酶 ; 高敏心肌肌钙蛋白 ; 早期诊断 英文关键词：acute myocardial infarction;;periosteal protein;;human myeloperoxidase;;high-sensitivity cardiac troponin;;early diagnosis 中文刊名：HBYZ 英文刊名：Hebei Medical Journal 机构：上海市奉贤区中心医院急诊科; 出版日期：2019-03-26 出版单位：河北医药 年：2019 期：v.41 语种：中文; 页：HBYZ201906005 页数：4 CN：06 ISSN：13-1090/R 分类号：25-28

摘要

目的血清骨膜蛋白(PN)、人髓过氧化物酶(MPO)和高敏心肌肌钙蛋白(hs-cTnT)在急性心肌梗死患者中预测心血管不良事件的临床价值。方法选择2015年1月至2017年12月就诊的急性心肌梗死患者120例,为急性心肌梗死组;选择同期就诊的慢性心力衰竭患者45例和健康体检者30例分别为慢性心力衰竭组和对照组。观察对照组,慢性心力衰竭组和急性心肌梗死组的PN、MPO和hs-cTnT水平变化,急性心肌梗死患者PN、MPO和hs-cTnT水平与心肌梗死严重程度,不良心血管事件和各指标之间的相关性分析及联合PN、MPO和hs-cTnT指标对不良心血管事件的预测作用。结果急性心肌梗死组的血清PN、MPO和hs-cTnT水平明显高于慢性心力衰竭组和对照组(P<0.01),而慢性心力衰竭组明显高于对照组(P<0.01)。急性心肌梗死患者血清PN、MPO和hs-cTnT水平随着心肌梗死严重程度的增加而升高(P<0.01)。MACE组的血清PN、MPO和hs-cTnT水平明显高于非MACE组的水平(P<0.01)。急性心肌梗死患者血清PN水平与MPO(r=0.671,P<0.01)和hs-cTnT(r=0.734,P<0.01)水平呈正相关,同时MPO水平与hs-cTnT水平同样呈正相关(r=0.818,P<0.01)。在预测不良心血管事件方面,联合检测的曲线下面积0.973,灵敏度为94.7%和特异性为93.9%明显优于PN(Z=3.087,P<0.01),MPO(Z=2.767,P<0.01)和hs-cTnT(Z=3.411,P<0.01),而PN、MPO和hs-cTnT的曲线下面积之间的比较差异无统计学意义(P>0.05)。结论 PN、MPO和hs-cTnT参与了急性心肌梗死的发生发展,联合检测对于早期诊断急性心肌梗死和不良心血管事件的预测具有重要临床价值。
        Objective To evaluate the clinical value of serum periostin(PN), human myeloperoxidase(MPO) and high-sensitivity cardiac troponin(hs-cTnT) in predicting cardiovascular adverse events in patients with acute myocardial infarction(AMI).Methods A total of 120 patients with AMI who were treated in our hospital from January 2015 to December 2017 were selected as AMI group. Forty-five patients with chronic heart failure(CHF) who were treated during the same period and 30 healthy subjects were enrolled as CHF group and control group respectively. The changes of PN, MPO and hs-cTnT levels in the control group, CHF group and AMI group were observed. The correlation of the levels of PN, MPO and hs-cTnT in patients with AMI to the severity of myocardial infarction, adverse cardiovascular events and indicators was analyzed between the two groups, and the combination of PN, MPO and hs-cTnT indicators for predicting adverse cardiovascular events was also analyzed.Results The seum levels of PN, MPO and hs-cTnT in AMI group were significantly higher than those in CHF group and control group(P<0.01), which in CHF group were significantly higher than those in control group(P<0.01). The serum levels of PN, MPO and hs-cTnT in patients with AMI were increased with the severity of myocardial infarction(P<0.01).The seum levels of PN, MPO and hs-cTnT in MACE group were significantly higher than those in non-MACE group(P<0.01). The srum levels of PN in patients with AMI were positively correlated with those of MPO(r=0.671, P<0.01) and hs-cTnT(r=0.734,P<0.01), while MPO levels were also positively correlated with hs-cTnT levels(r=0.818, P<0.01). In predicting adverse cardiovascular events, the area under the curve(AUC) by combination detection was 0.973, and the sensitivity and the specificity were 94.7% and 93.9%,respectively, which was significantly better than that of PN(Z=3.087,P<0.01), MPO(Z=2.767,P<0.01) and hs-cTnT(Z=3.411,P<0.01). However, the difference between AUC of PN, MPO and hs-cTnT was not statistically significant(P>0.05).Conclusion PN, MPO and hs-cTnT are involved in the development of AMI. Therefore, combination detection has important clinical value in early diagnosis of AMI and adverse cardiovascular events.

引文

1 Yokoyama H,Higuma T,Endo T,et al.“30-minute-delta” of high-sensitivity troponin I improves diagnostic performance in acute myocardial infarction.J Cardiol,2018,71:144-148.
    2 Gong X,Zhang B,Piao J,et al.High sensitive and multiple detection of acute myocardial infarction biomarkers based on a dual-readout immunochromatography test strip.Nanomedicine,2018,14:1257-1266.
    3 齐静,周玉杰.人血浆骨膜蛋白水平与急性心肌梗死相关性的研究.中国医药,2017:481-485.
    4 Sygitowicz G,Maciejak A,Piniewska-Juraszek J,et al.Interindividual variability of atorvastatin treatment influence on the MPO gene expression in patients after acute myocardial infarction.Acta Biochim Pol,2016,63:89-95.
    5 Kimenai DM,Janssen E,Eggers KM,et al.Sex-Specific Versus Overall Clinical Decision Limits for Cardiac Troponin I and T for the Diagnosis of Acute Myocardial Infarction:A Systematic Review.Clin Chem,2018,64:1034-1043.
    6 潘露,闵瑶.血清骨膜蛋白对急性心肌梗死的诊断价值研究.检验医学与临床,2016,13:2286-2287.
    7 欧登科,邹玲,邹德玲,等.急性ST段抬高型心肌梗死患者骨膜蛋白水平变化的临床意义.中国动脉硬化杂志,2016,24:1039-1043.
    8 凌琳,承燕,顾少华.急性心肌梗死患者血清骨膜蛋白水平与疾病预后的关系.中国动脉硬化杂志,2016,24:698-700,704.
    9 Dullaart RP,Tietge UJ,Kwakernaak AJ,et al.Alterations in plasma lecithin:cholesterol acyltransferase and myeloperoxidase in acute myocardial infarction:implications for cardiac outcome.Atherosclerosis,2014,234:185-192.
    10 Kaya MG,Yalcin R,Okyay K,et al.Potential role of plasma myeloperoxidase level in predicting long-term outcome of acute myocardial infarction.Tex Heart Inst J,2012,39:500-506.
    11 Miranda DF,Lobo AS,Walsh B,et al.New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department.Can J Cardiol,2018,34:132-145.
    12 Greenslade J,Cho E,Van Hise C,et al.Evaluating Rapid Rule-out of Acute Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay at Presentation.Clin Chem,2018,64:820-829.
    13 Ambavane A,Lindahl B,Giannitsis E,et al.Correction:Economic evaluation of the one-hour rule-out and rule-in algorithm for acute myocardial infarction using the high-sensitivity cardiac troponin T assay in the emergency department.PLoS One,2018,13:e191348.
    14 Pickering JW,Than MP,Cullen L,et al.Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection:A Collaborative Meta-analysis.Ann Intern Med,2017,166:715-724.
    15 Twerenbold R,Jaeger C,Rubini GM,et al.Impact of high-sensitivity cardiac troponin on use of coronary angiography,cardiac stress testing,and time to discharge in suspected acute myocardial infarction.Eur Heart J,2016,37:3324-3332.