不稳定型心绞痛患者血清妊娠相关蛋白A与颈动脉粥样硬化的相关性

目的探讨颈动脉粥样硬化、血清妊娠相关性蛋白A与不稳定型心绞痛、稳定型心绞痛、非冠心病的相关性。方法因胸痛入院的患者1 w内行冠脉造影,排除急性及亚急性心梗后,不稳定型心绞痛、稳定型心绞痛、非冠心病各40例被纳入研究中,进行冠状动脉Gensini评分;彩超检测颈动脉内中膜厚度、斑块形成情况,应用酶联免疫吸附法测定血清妊娠相关蛋白A水平,并进行统计学分析。结果除吸烟史外,各组间其余基线资料匹配;不稳定型心绞痛、稳定型心绞痛的冠脉Gensini评分、颈动脉粥样硬化指标均较非冠心病高(P<0.001);不稳定型心绞痛组比稳定型心绞痛及非冠心病组血清妊娠相关蛋白A的浓度高(P<0.001),妊娠相关蛋白A在不稳定型心绞痛患者明显升高,其与颈动脉粥样硬化指标、冠脉Gensini积分正相关;Crouse积分预测心绞痛型冠心病,敏感度、特异度分别为0.79、0.92;颈动脉内中膜厚度平均值预测心绞痛型冠心病敏感度、特异度分别为0.97、0.85;妊娠相关蛋白A预测不稳定型心绞痛敏感度、特异度分别为0.825、0.937。结论颈动脉粥样硬化指标与冠状动脉Gensini积分有较好的相关性,而妊娠相关蛋白A可作为预测不稳定型心绞痛的指标;二者联合检测可能是预测不稳定型心绞痛的重要临床依据。

The relevance between carotid atherosclerosis and serum pregnancy-associated protein A of unstable angina patients

Objective To investigate the relevance between carotid atherosclerosis,serum pregnancy-associated protein A(PAPP-A) and the incidence of unstable angina(UAP),stable angina pectoris(SAP),Non-coronary heart disease(NCHD),to further discuss joint significance of carotid atherosclerosis and PAPP-A concentration in the forecast of UAP.Methods Patients admitted to hospital because of chest pain,coronary angiography were completed within 1 w,which with acute and subacute myocardial infarction had been excluded,then,40 case of UAP,40 cases of SAP,40 cases of NCHD were taken.Gensini score,intima-media thickness(IMT) of carotid artery,plaque formation of carotid artery were determined by color doppler ultrasound,serum levels of PAPP-A was determined by enzyme-linked immunosorbent assay(ELISA).Results In addition to smoking history,baseline informations of the groups were matched each other;coronary Gensini score,indicators of carotid atherosclerosis of UAP and SAP groups were higher than those of NHCD group(P<0.001);serum concentration of PAPP-A of UAP was higher than that of SAP and NHCD groups(P<0.001);PAPP-A in patients with UAP was significantly higher,and its concentration was correlated with indicators of carotid atherosclerosis,coronary artery Gensini score.The sensitivity and specificity of Crouse score predicting angina-type CHD were 0.79,0.92 respectively;the sensitivity and specificity of average of Carotid IMT predicting angina-type CHD were 0.97,0.85 respectively;the sensitivity and specificity of PAPP-A predicting UAP were 0.825,0.937 respectively.Conclusions Indicators of carotid atherosclerosis and coronary artery Gensini score have good correlation,and PAPP-A as a predictable indicator of UAP;the two indicators may be important clinical basis to predict UAP.