急性心肌梗死患者介入治疗术后髓过氧化物酶的早期变化及意义
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Early Dynamic Changes and Clinical Significance of Myeloperoxidase after Intervention Treatment in Patients with Acute Myocardial Infarction
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    目的 观察急性心肌梗死患者介入治疗术后早期髓过氧化物酶(MPO)的动态变化,初步探讨术后MPO水平对经皮冠状动脉介入(PCI)治疗患者住院期间主要不良心血管事件(MACE)发生情况的预测价值。方法选取发病在12 h内、初次因胸痛就诊的急性心肌梗死患者68例,根据是否行PCI治疗分为支架组(46例)和保守组(22例)。并选取冠状动脉血管正常的15例患者作为正常对照组。分别于术前(T0)及术后30 min、4 h、12 h、24 h(T1~T4)抽取外周肘静脉血,用酶联免疫吸附法检测MPO和高敏C反应蛋白(hs-CRP)的水平,记录支架组住院期间MACE的发生情况。结果 支架组和保守组术前的MPO和hs-CRP水平无差异(P>0.05),但均高于正常对照组(P<0.01)。术后支架组与保守组MPO和hs-CRP的表达均有所增加。支架组MPO、hs-CRP水平分别在T2、T4时达高峰,均高于术前(P<0.01)。保守组MPO和hs-CRP水平呈缓慢上升趋势,均于T4时升至最高。支架组MPO、hs-CRP峰值均显著高于保守组(P<0.01)。正常对照组MPO和hs-CRP水平均无动态变化(P>0.05)。住院期间支架组有9例发生MACE,经受试者工作特征曲线分析,T2时的MPO水平可预测院内MACE的发生情况(曲线下面积为0.823,界值为792.850 μg/L,灵敏度88.9%,特异度70.3%,P=0.003)。结论 MPO是急性心肌梗死患者PCI术后早期炎症反应的敏感指标,在PCI术后早期就已明显升高并达高峰;PCI术后4 h的MPO水平对院内MACE的发生具有一定的预测价值,且优于术前。

    Abstract:

    Aim To observe the early dynamic changes of the serum level of myeloperoxidase (MPO) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), and investigate the prognostic value of MPO for in-hospital major adverse cardiovascular events (MACE) in AMI patients treated by PCI. MethodsA total of 68 consecutive patients hospitalized with chest pain for the first time who had the onset of symptoms within 12 h were selected and arteriography was performed. They were divided into 44 patients treated by PCI (stent group) and 22 patients assessed by coronary angiography only (angiography group). And 15 patients with normal coronary arteries were selected as normal control group. Blood samples were collected at baseline (T0) and 30 min, 4 h, 12 h and 24 h (T1, T2, T3, T4) after surgery, MPO and high-sensitive C-reactive protein (hs-CRP) were measured using an enzyme-linked immunosorbent assay (ELISA). Patient in-hospital MACE of stent group was recorded. Results (1)Both MPO and hs-CRP levels were significantly higher in stent or angiography group than in normal control group, but there were no significant difference between the stent and angiography group. (2)The MPO and hs-CRP levels of stent group reached to the peak at T2, T4, respectively, and were significantly higher than T0 (P<0.01). Both MPO and hs-CRP of the two groups all showed a trend of gradually increasing, and reached to their highest value. The peak value of the two factors in stent group were higher than that in angiograph group significantly (P<0.01). No dynamic changes in levels of MPO and hs-CRP were found in normal control group before and after arteriography at the different time points. (3)There was a total of 9 patients with MACE during the hospitalization in stent group. The receiver operating characteristic curve (ROC curve) analysis revealed the level of MPO at T2 had the highest predictive value for MACE [area under curve (AUC)=0.823, cut-off point=792.850 μg/L, sensitivity=88.9%, specificity=70.3%, P=0.003]. Conclusions MPO is a sensitive resemble of the early inflammatory response in patients with AMI after PCI. It significantly elevated and rapidly reached to the peak in the early stage after PCI. And the predictive value of MPO after PCI was superior at preoperative for in-hospital MACE due to the patients with AMI treated by PCI.

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王慧洁,丁世芳,侯 云,蒋桔泉,付文波,王 华,陈志楠.急性心肌梗死患者介入治疗术后髓过氧化物酶的早期变化及意义[J].中国动脉硬化杂志,2014,22(5):513~517.

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  • 收稿日期:2013-10-15
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