急性冠状动脉综合征患者血清PAPP-A、hs-CRP水平变化及临床意义

目的探讨急性冠状动脉综合征（ACS）患者血清妊娠相关血浆蛋白A（PAPP—A）、高敏C反应蛋白（hs—CRP）的变化及临床意义。方法采用时间分辨免疫荧光分析法检测30例急性心肌梗死（AMI）患者、21例不稳定心绞痛（UAP）患者、25例稳定性心绞痛（SAP）患者和20名正常对照者血清PAPP—A，同时用乳胶增强比浊法检测血清hs—CRP。结果SAP组血清PAPP—A水平与正常对照组比较无差异（P〉0．05）；UAP组和AMI组血清PAPP—A水平均明显高于正常对照组和SAP组（P均〈0．01），但UAP组血清PAPP—A水平与AMI组比较无差异。SAP组血清hs—CRP水平明显高于正常对照组（P〈0．05）；UAP组明显高于正常对照组和SAP组（P〈0．01），但低于AMI组（P〈0．01）。ACS组血清PAPP—A水平与血清hs—CRP水平呈正相关（r=0．53，P〈0．01）。结论ACS患者血清PAPP—A与hs—CRP水平均明显升高，且hs—CRP与PAPP—A之问存在明显相关性。PAPP—A水平升高可能与动脉粥样硬化斑块的不稳定性有关，提示可作为识别ACS的早期血清学标志物。

The change and clinical significance of serum pregnancy-associated plasma protein A and high sensitive C reactive protein in patients with acute coronary syndrome

Objective To investigate the changes and the clinical significance of serum pregnancy-associated plasma protein A(PAPP-A)and high sensitive C reactive protein (hs-CRP) in patients with acute coronary syndrome(ACS). Methods The serum levels of PAPP-A in 30 acute myocardial infarction(AMI)patients,21 unstable angina pectoris (UAP) patients,25 stable angina pectoris (SAP) patients and 20 healthy controls were determined by time-resolved fluoroimmunoassay(TRFIA); the levels of hs-CRP were determined by immune enhancement nephelometry simultaneously. Results The levels of PAPP-A in UAP patients and AMI patients were significantly higher than those in SAP patients and healthy controls(P<0.01), while there was no statistically significant difference between UAP patients and AMI patients or between SAP patients and healthy controls. The levels of hs-CRP in SAP patients were significantly higher than those in healthy controls (P<0.05); the levels of hs-CRP in UAP patients were significantly higher than those in healthy controls and SAP patients (P<0.01), but were lower than those in AMI patients (P<0.01). The levels of PAPP-A in patients with ACS were positively correlated with the levels of hs-CRP (r=0.53, P<0.01). Conclusions The serum levels of PAPP-A and hs-CRP in patients with ACS significantly increase and are positively correlated. The PAPP-A levels′ increasing may be associated with unstable plaque and may become a new candidate marker for early diagnosis of ACS.