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

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.%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 thehealthy 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.