血清妊娠相关性血浆蛋白-A在不稳定性心绞痛发病中的意义

目的]通过比较不稳定心绞痛(unstable angina,UA)、稳定心绞痛(stable angina,SA)和非冠心病对照患者血清妊娠相关性血浆蛋白-A (Pregnancy associated plasma protein A,PAPP-A)水平,及与冠脉狭窄程度、病变支数和冠脉斑块形态的关系,探讨PAPP-A水平变化在UA发病中的意义.方法]记录入选者一般资料,测定UA(50例)、SA(45例)和对照组(30例)患者血清PAPP-A、C-反应蛋白(C-reactive protein,CRP)、血糖、血脂水平；入选者根据造影冠脉积分将冠心病患者分为轻度、中度和重度病变组,按造影斑块形态分为Ⅰ、Ⅱ和Ⅲ型病变组.结果]UA组PAPP-A水平明显高于SA与对照组患者(P＜ 0.01);UA与SA患者Ⅱ斑块数量为70％:20％ (P＜ 0.01),Ⅱ型斑块病变组PAPP-A水平明显高于Ⅰ、Ⅲ型斑块病变组(P＜ 0.01)；PAPP-A与CRP存在明显正相关(r=0.395,P=0.005),与年龄、血脂、血糖以及冠脉病变支数、冠脉狭窄程度无明显相关(P＞0.05).结论]PAPP-A与冠脉不稳定斑块发生、发展有关,对预测冠心病患者冠脉斑块稳定性有一定临床价值.

Clinical significance of the serum levels of pregnancy-associated plasma protein-A in unstable angina patients

【Objective】To investigate the clinical significance of pregnancy associated plasma protein-A(PAPPA) in the onset of unstable angina.【Methods】 Fifty cases with unstable angina(UA),forty-five cases with stable angina(SA) and thirty patients with no coronary artery disease were enrolled in this study.The diagnostic catheterization for severity of lesion,complexity,angiographic plaque morphology.PAPP-A,C-reactive protein(CRP),glucose and lipid levels were measured.【Results】 The serum PAPP-A levels were significant higher in UA patients with angiographic features of complex and unstable plaque than that in patients with SA,stable plaque features,and no coronary artery disease.Spearman Analysis showed that PAPP-A concentration was positively correlated with CRP levels and number of the unstable lesions,but not correlated with age,lipid profile,fasting glucose,number of vessel stenosis and severity.【Conclusion】The results in the present study suggest that PAPP-A might involve with formation and progression of the atherosclerotic plaques and has a predictive importance for instability of the vulnerable plaques.