目的 探讨急性冠脉综合征(ACS)患者血浆正五聚蛋白-3(PTX-3)和超敏C反应蛋白(hs-CRP)的水平变化及其与近期预后的关系.方法 连续入选徐州医学院附属医院心内科2012年1-4月临床确诊并经冠状动脉造影证实为冠心病(CAD)患者180例,包括40例ST段抬高性心肌梗死患者(STEMI组)、40例非ST段抬高性心肌梗死患者(NSTEMI组)、50例不稳定性心绞痛患者(UAP组)和50例稳定性心绞痛患者(SAP组).另选取同期条件相匹配以胸痛待查入院且经造影检查正常者30例为正常对照组(NC组).各组受试者入院第2天检测空腹血浆PTX-3、hs-CRP水平及各项血常规生化指标.对所有患者随访6个月,终点为心源性死亡、再住院等主要不良心脏事件(MACE).结果 (1)ACS各组患者的血浆PTX-3水平、hs-CRP水平及血脂水平与NC组比较,差异均有统计学意义(P＜0.05).STEMI组与NSTEMI组、NSTEMI组与UAP组、UAP组与SAP组动脉硬化指数(ASI)、PTX-3和hs-CRP水平比较,差异均有统计学意义(P＜0.05).NSTEMI组与UAP组间的ASI、PTX-3和hs-CRP水平比较,差异无统计学意义(P＞0.05).SAP组与NC组的总胆固醇(TC)和低密度脂蛋白水平(LDL)水平间差异有统计学意义(P＜0.05).(2)ACS患者血浆PTX-3水平与hs-CRP水平、ASI、Gensini积分、TC、LDL呈正相关(P＜0.01).(3)130例ACS患者中发生心源性死亡12例,因心力衰竭或ACS再住院36例,血浆PTX-3及其标化值、hs-CRP预测CAD患者发生MACE的受试者工作特征(ROC)曲线下面积分别为0.90、0.76、0.66,血浆PTX-3及其标化值对ACS患者MACE发生的预测价值较hs-CRP高,有更好的敏感度和特异度.(4)采用二分类Logistic回归分析影响ACS患者近期预后的危险因素,结果显示血浆PTX-3、PTX-3标化值和N端B型钠尿肽前体(NT-proBNP)能明显影响ACS患者的近期预后(P＜0.05).结论 血浆PTX-3与ACS的关系密切,在预测ACS的预后方面可能有更好的敏感度和特异度.%Objective To evaluate the prognostic value of levels of pentraxin - 3 ( PTX - 3 ) and hypersensitive C -reaction protein ( hs - CRP ) in patients with acute coronary syndromes ( ACS ) in the near future.Methods A total of 180 patients diagnosed by coronary angiography as coronary artery disease ( CAD ) were divided into groups STEMI ( ST segment elevation myocardial infarction, n = 40 ), NSTEMI ( non - STEMI, n = 40 ), UAP ( unstable angina pectoris, n = 50 ), SAP ( stable angina pectoris, n =50 ).Another 30 normal subjects were enrolled as NC group ( normal control ).Fasting blood PTX - 3 and hs - CRP and other blood biochemical parameters were determined on days 2 after admission.All patients were followed up for 6 months.The end points were cardiac death ( CD ), re - hospitalization and other main adverse cardiac events ( MACE ).Results There was significant difference in plasma PTX - 3, hs - CRP and lipid levels between groups ACS and NC ( P < 0.05 ), and in atherosclerosis index ( ASI ), PTX - 3 and hs - CRP between groups STEMI and NSTEMI, between groups NSTEMI and UAP, between groups UAP and SAP, but there was no between groups NSTEMI and UAP ( P >0.05 ).SAP group was different from NC group in total cholesterol ( TC ) and low - density lipoprotein ( LDL) ( P < 0.05 ).The PTX - 3 level was positively correlated with hs - CRP, ASI, Gensini scores, TC and LDL in ACS patients ( P <0.01 ).Among 130 ACS patients,12 died of CD, re -hospitalized due to heart failure or ACS, the areas under the ROC of MACE predicted by plasma PTX - 3 and its standardized value ( PTX - 3/hs - CRP ), hs - CRP were 0.90, 0.76, 0.66, respectively.The predictive values of plasma PTX - 3 and its standardized values were higher than that of hs - CRP and had better sensitivity and specificity.Binary Logistic regression analysis of the risk factors influencing ACS patients' short - term prognosis showed that plasma PTX - 3 and its standardized value, NT - proBNP influenced remarkably the short - term prognosis of ACS patients ( P < 0.05 ).Conclusion Plasma PTX - 3 has closer relationship with ACS and may have better sensitivity and specificity in predicting ACS prognosis.
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