髓过氧化物酶在非ST段抬高急性冠状动脉综合征诊断和预后中的临床应用

目的 评价血清髓过氧化物酶(MPO)对非ST段抬高心肌梗死(NSTE MI)的诊断价值,并探讨其与非ST段抬高急性冠状动脉综合征(NSTE ACS)的预后关系。方法 检测61例不稳定心绞痛(UAP)和54例NSTE MI患者血清髓过氧化物酶(MPO)和心肌肌钙蛋白(cTnI)水平,应用受试者工作特征曲线(ROC Curve)比较MPO和cTnI对NSTE MI的价值; 同时随访比较106例NSTE ACS患者1年内发生主要心脏不良事件的发生情况。结果 NSTE MI组与UAP组MPO值分别为672±418 ng/ml 和459±328 ng/ml,差异有统计学意义(t=3.928,P＜0.001)。cTnI值分别为558±261 pg/ml和405±278 pg/ml,差异均有统计学意义(t=3.089,P=0.003)。ROC曲线分析结果显示MPO诊断NSTE MI的最佳cutoff值382 ng/ml,此时曲线下面积0.726,敏感度92.6%,特异度39.8%; cTnI的最佳cutoff值484 pg/ml,此时曲线下面积0.799,敏感度65.5%,特异度92.3%。MPO是NSTE ACS患者1年内发生主要心脏事件的独立危险因子,风险比值(OR)3.085(95% CI 1.585～5.662,P=0.032)。结论 MPO对 NSTEMI的诊断具有较高敏感度,可辅助cTnI诊断NSTE MI,对NSTE ACS患者具有预后判断价值。

Clinical Application of Myeloperoxidase in Diagnosis and Prognosis of Non-ST Elevation Acute Cornary Syndromes

Objective To evaluate the diagnostic value of myeloperoxidase(MPO)in diagnosis of non-ST elevation acute coronary syndromes(NSTE ACS).Methods The MPO was determined in 61 unstableangina pectoris(UAP)patients and 54 non-ST-elevation myocardial infarction(NSTE MI)patients,then analyzed the data with receiver operationg characteristic curve(ROC curve)statistical software.The major adverse cardiac events(MACE)were obseved in 106 NSTE ACS patients through 1 year of follow-up.Results The MPO values of NSTE MI group and UAP group were 672±418 ng/ml and 459±328 ng/ml,the difference was statistically significant(t=3.928,P＜0.001).The cTnI values were 558±261 pg/ml and 405±278 pg/ml of respectively.The difference was statistically significant(t=3.089,P=0.003).The area under the ROC curve of MPO was 0.726 when the optimal cutoff valuewas 382 ng/ml in the diagnosis of NSTE MI.The sensitivity and specificity was 92.6% and 39.8%.The area under the ROC curve of cTnI was 0.799 when the optimal cutoff value was 484 ng/ml in the diagnosis of NSTE MI.The sensitivity andspecificity was 65.5% and 92.3%.High MPO maintained a strong association withthe risk of major adverse cardiac events through 1 year of follow-up.Conclussion MPO is ahigh sensitivity marker of the NSTE MI and of clinical value for prognosis of NSTE ACS.