髓过氧化物酶与急性冠状动脉综合征的相关性研究

目的探讨冠状动脉内粥样硬化斑块不同稳定程度患者的血清髓过氧化物酶(myeloperoxidase,MPO)水平的变化。方法检测23例ST段抬高的急性冠状动脉综合征(STEACS组)患者、27例非ST段抬高的急性冠状动脉综合征(NSTEACS组)患者4、8例稳定性心绞痛(SAP组)患者以及55例对照组患者的血清MPO、肌钙蛋白T(cTnT)、高敏C反应蛋白(hs-CRP)等主要指标的水平,同时通过冠状动脉造影进行对比研究。结果ACS患者血清MPO水平明显高于SAP组和对照组,尤以STEACS组增高更显著,并随着血清MPO的增高,发生ACS的风险越大,血清MPO水平最高四分位组发生ACS的OR是最低四分位组的4.6倍(95%CI:1.6~13.4),而且比hs-CRP和绝对中性粒细胞数(ANC)预测发生ACS的风险更强;冠状动脉不同狭窄程度各组之间血清MPO水平的差异有统计学意义;cTnT<0.1μg/L患者占74.7%,且其中血清MPO水平最高四分位组发生ACS是最低四分位组的4.9倍;MPO与hs-CRP、ANC无明显相关关系,是ACS独立的危险因素。结论血清MPO水平与ACS的严重程度显著相关,尤其当cTnT水平较低时,它能早期独立预测ACS的发生。

A study of correlation between myeloperoxidase and acute coronary syndrome

Objective To evaluate the association between serum myeloperoxidase(MPO) level and coronary plaque vulnerability.Methods Serum levels of MPO,cardiac troponin T(cTnT) and high-sensitivity C-reactive protein(hs-CRP) were assessed in 23 pateints with ST-segment elevation acute coronary syndrome(STEACS),27 with non-ST-segment elevation acute coronary syndrome(NSTEACS),48 with stable angina(SAP) and 55 healthy patients(controls).Coronary angiography was conducted for comparison.Results MPO serum levels were significantly higher in patients with acute coronary syndrome(ACS),particularly with STEACS,than in those with SAP or controls,and the OR of ACS increased with increasing MPO levels with an OR of 4.6(95%CI,1.6～13.4) for the highest vs lowest quartiles.MPO serum levels were signifcantly greater in patients with established coronary artery disease than without angiographically significant coronary artery disease.For patients with initially low(cTnT)(<0.1 μg/L),the OR of ACS increased with increasing MPO levels with an OR of 4.9(95%CI,1.0～26.8) for the highest vs lowest quartiles.MPO serum levels were not significantly correlated with hs-CRP and absolute neutrophil count(ANC),it was an independent risk factor of ACS.Conclusion Elevated serum levels of MPO are associated with coronary plaque vulnerability and can independently predict the risk of ACS,particularly in patients with initially low cTnT.