急性心肌梗死患者血浆妊娠相关蛋白A与可溶性白细胞分化抗原配体变化及意义

目的 探讨急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）术前及术后妊娠相关蛋白A（PAPP-A）与可溶性白细胞分化抗原配体（sCD40L）的变化及意义.方法 采用固相夹心酶联免疫法测定50例AMI患者发病后6～12 h（PCI术前）,术后24 h、48 h、72 h、5 d、7 d、14 d及25例对照组PAPP-A和sCD40L浓度.将AMI组分为3个亚组：死亡组、并发症组及无并发症组.结果 AMI组与对照组比较,术前血浆PAPP-A[（27.84±6.37）pg/ml比（10.69±2.48）pg/ml,P〈0.01]和sCD40L[（555.40±63.63）ng/L比（343.24±26.35）ng/L,P〈0.01]差异有统计学意义;在3个亚组中,无并发症组血浆PAPP-A及sCD40L术后24 h迅速达高峰,之后逐渐下降,5～7 d恢复至正常水平.并发症组及死亡组血浆PAPP-A及sCD40L显著高于无并发症组,且随着并发症持续时间的延长两种炎症因子浓度维持在较高水平;死亡组术后持续升高,术后14 d仍然居于很高水平.三组的组间、不同时间点,以及组间和不同时间点的交互作用差异均有统计学意义（P〈0.05）.结论 AMI患者血浆PAPP-A与sCD40L浓度明显升高,其峰值延迟甚至持续升高可能提示病情严重,二者浓度的动态变化对AMI患者PCI术后近期不良心脏事件及并发症的发生有一定预测价值.

Changing and significance of plastic PAPP-A and sCD40L in patients with acute myocardial infarction

Objective To investigate the changing and significance of pre- and post-operation plasma pregnancy-associated plasma protein-A （PAPP-A） and sCD40L in patients with acute myocardial infarction. Methods Plasma level of PAPP-A and sCD40L were assayed within the onset 6-12 h of AMI （before PCI） and post-operation 24 h, 48 h, 72 h, 5 d, 7 d and 2 weeks adopted ELISA in 50 AMI patients. The AMI group was div/ded into 3 sub-groups： the death group, the complication group and the non-complication group. Meanwhile, the plasma level of the two inflammatory factors in 25 controls also were detected at pre-operation （coronary artery angiography）. Results Plasma level of PAPP-A and sCD40L at pre-operation were higher in patients with AMI than those of controls, respectively PAPP-A（27.84±6.37）pg/ml vs （10.69±2.48）pg/ml, sCD40L（555.40±63.63） ng/L vs（343.24±26.35）ng/L（each P〈0.01 ）. In the three sub-groups, plasma concentration of PAPP-A and sCD40L was increased qtrlcldy in the non-complication group within the first 24 h of PCI, and then decreased gradually, restored to normal level after 5-7 days. The more serious condition, the more delayed in the peak value, the plasmas level of the complication group and the death group had not been dropped to preoperative level until 14 days after operation, while the death group was still higher than preoperative levels. Among three groups, the different time points and the interaction of among groups and the different time points, the three differences were statistically significance. Conclusion The concentration of plasma PAPP-A and sCD40L is significantly increased in patients with AMI, the peak which was delayed or continued not to descend demonstrates a serous condition, the simultaneous determination of both in AMI patients can be used as short-term prognostic indicators after emergency PCI.