髓过氧化物酶早期识别急性冠状动脉综合征的临床价值

目的:探讨髓过氧化物酶(MPO)浓度与急性冠状动脉综合征(ACS)的关系及其早期识别ACS的临床价值。方法: 采用酶联免疫吸附法测定血浆MPO浓度。 结果: ACS组患者血浆MPO浓度明显升高，与正常对照组、稳定型心绞痛（SAP）组比较差异有统计学意义（P<0.05）。SAP组血浆MPO浓度高于正常对照组（P<0.05）。血浆MPO浓度与中性粒细胞、肌酸激酶同工酶及受试组呈正相关，与年龄、高敏感C反应蛋白、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、三酰甘油、天冬氨酸氨基转移酶、空腹血糖、乳酸脱氢酶、红细胞计数、血小板计数无相关性。依据临床表现和冠状动脉造影，临床诊断ACS 41例, 非ACS组37例，绘制ROC曲线（A=0.927，P=0.000）。MPO诊断界值为212.59 μg/L，MPO≥212.59 μg/L为阳性，诊断为ACS，MPO<212.59 μg/L为阴性，诊断非ACS。临床诊断ACS 41例中，MPO阳性39例，阴性2例，非ACS组37例中，MPO阳性5例，阴性32例，MPO诊断ACS灵敏度为95%,特异度为86%，准确度为91%，假阴性率(漏诊率)为5%，假阳性率(误诊率)为14%，阳性预测值为89%，阴性预测值为94%。本法与临床诊断ACS方法进行Kappa一致性检验，Kappa系数值为0.819，P=0.000，说明两种方法的吻合程度具有统计学意义，两法一致性较好。采用Logistic逐步回归，筛选出有统计学意义的影响因素为MPO 、低密度脂蛋白胆固醇和肌酸激酶同工酶，建立预测模型，MPO预测ACS总正确率为95%，提示MPO对ACS具有较高的预测价值。结论: MPO能有效地早期识别ACS。

Clinical value of myeloperoxidase in early identification of acute coronary syndrome

AIM: To explore the relationship between plasma concentrations of myeloperoxidase(MPO) and onset and progress of acute coronary syndrome(ACS) and the clinical value of MPO in the early identification of ACS.METHODS: MPO concentrations were measured by enzyme-linked immunosorbent assays(ELISA).RESULTS: Patients with ACS had significantly higher MPO concentrations than patients with stable angina pectoris(SAP) and control groups(P<0.05).Significant MPO differences were found between SAP patients and control groups(P<0.05).A positive correlation was observed between MPO and neutrophils as well as creatine kinase isoenzyme(CK-MB).MPO did not demonstrate a correlation with age,highly sensitive C-reactive protein(hs-CRP),white blood cell(WBC) count,total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglyceride(TG),aspartate aminotransferase(AST),fasting blood glucose(FBG),lactate dehydrogenase(LDH),red blood cell(RBC) count,and platelet count(PC).Forty-one patients in ACS group and 37 patients in the non-ACS group were diagnosed according to clinical manifestations and coronary angiography.The best cut-off point for MPO was identified as ≥212.59 μg/L using the ROC curve(A=0.927,P=0.000),revealing 39 patients with positive MPO in ACS when MPO was ≥212.59 μg/L and two patients with negative MPO in non-ACS group when MPO was <212.59 μg/L.Sensitivity,specificity and total consistent rate of MPO were,respectively,95%,86% and 91%.The false negative rate(the rate of misdiagnosis) was 5% and the false positive rate(misdiagnosis rate) was 14%.Positive and negative predictive values were 89% and 94%,respectively.Kappa value(0.819,P=0.000) showed that the two diagnostic methods were in good agreement.Logistic regression identified significant differences in MPO,LDL-C and CK-MB between ACS group and non-ACS group.A predictive model of ACS was established using these variables and the total correct rate of MPO in predicting ACS reached 94.9%.CONCLUSION: MPO is useful in the early identification of ACS.