早期急性心肌梗死患者血清白细胞介素-1受体拮抗蛋白变化的临床价值

目的探讨血清白细胞介素-1受体拮抗蛋白（IL-1Ra）在早期诊断急性心肌梗死（AMI）患者中的临床价值。方法比较IL-1Ra、肌红蛋白（MYO）、肌钙蛋白I（cTnI）、肌酸激酶同功酶（CK-MB）四种物质定量检测对诊断发病6h内的AMI的敏感性、特异性和准确性。结果 AMI组IL-1Ra水平高于非急性心肌梗死组和正常对照组（P均〈0.01）;AMI组和非急性心肌梗死组患者血清IL-1Ra含量进行Logistic回归分析得知,IL-1Ra诊断AMI的最佳临界值为210pg/ml。IL-1Ra诊断发病3h和6h内的AMI的敏感性显著高于cTnI和CK-MB（P〈0.05）,特异性差异则无统计学意义（P〉0.05）,诊断准确性高于MYO、cTnI和CK-MB。结论 IL-1Ra在AMI患者中早期升高对发病〈3h的AMI患者有诊断意义,提示检测IL-1Ra可作为早期诊断AMI的一个重要的辅助指标。

A Clinical Study on the Change of Interleukin-1 Receptor Antagonist in Patientes Whih Early Acute Myocardial Infarction

Objective To study the clinical value of using interleukin-1 receptor antagonist（IL-1Ra）as a marker in patients with early acute myocardial infarction（AMI）.Methods The level of plasma IL-1Ra was measured by sandwich ELISA in 98 patients with suspected AMI.Measurement was performed within 6 hours after admission.48 normal healthy subjects were used as control.The concentrations of plasma cardiac troponin-I（cTnI）,creatine kinaseMS（CK-MB）and myoglobin（MYO）were determined at the same time.The validity of diagnosis was based on the sensitivity,specificity and accuracy and the tests.Results The level of IL-1Ra in patients with AMI was higher than both of non-infarction angina and the normal group（P〈0.01）.The threshold level of IL-1Ra in the diagnosis of AMI was found to be 210 pg /ml.Sensitivity on the testing of IL-1Ra in the initial 3 to 6 hours is higher than the testing of cTnI and CK-MB（P〈0.05）.The testing method was specific and the accuracy was greater than the testing of MYO,cTnI and CK-MB.Conslusion Unlike the markers of necrosis,an increase in the level of 1L-1Ra（3 hrs）in patients with AMI may be used in the early diagnosis of AMI.