血清妊娠相关血浆蛋白A与急性冠状动脉综合征的临床相关性

目的探讨急性冠脉综合征患者妊娠相关血浆蛋白A水平与高敏C反应蛋白的关系及与动脉粥样硬化斑块稳定性的关系。方法选择急性冠状动脉综合征(ACS)患者43例,稳定性心绞痛(SA)患者25例,对照组15例,进行对比分析,ACS中不稳定性心绞痛(UA)20例,急性心肌梗死(AMI)23例;心绞痛组和对照组于入院次日晨抽取外周静脉血,AMI组于发病12 h内抽取静脉血。采用酶联免疫吸附法(ELISA法)检测血清妊娠相关血浆蛋白(PAPP-A),散射比浊法检测C-反应蛋白(CRP)浓度,进行各组间PAPP-A、CRP含量比较。结果ACS组与稳定型心绞痛组和对照组之间相比,高敏C反应蛋白和妊娠相关血浆蛋白A水平的差异均有显著性(P<0.01);妊娠相关血浆蛋白A水平与高敏C反应蛋白呈正相关(r=0.158);多因素回归分析显示妊娠相关血浆蛋白A水平与高敏C反应蛋白呈正相关直线关系。结论妊娠相关血浆蛋白A水平可作为临床评估冠心病患者病情稳定程度,并进而可能成为评价冠状动脉斑块稳定性的指标之一。

The clinical relevance between the serum level of pregnancy-associated plasma protein-A and degree of acute coronary syndrome

Objecitve To investigate the relationship between the level of pregnancy-assoiated plasma protein-A(PAPP-A) and high-sensitivity C-reactive protein(hs-CRP) in patiente with acute coronary syndrome(ACS) and the role of PAPP-A in predicting the stability of atherosclerotic plaques.Methods A total of 43 patients were selected as ACS group,25 patients as stable angina(SA) and 13 persons as control.ACS group ansisted of 20 patients with unstable angina(UA) and 23 patients with acute myocardial infarction(AMI).The peripheral venous blood samples of the both control and angina groups were drawn on the morning of the following day after hospitalization, and of the AMI group were drawn 24 hours after episode.The concentration of PAPP-A was detected by enzyme-linked immune sorbent assay(ELISA),and the concentration of C-reactive protein(CRP) was detected by scatter turbidimetry method.The concentration of PAPP-A and CRP in each group was compared.Results The plasma hs-CRP and PAPP-A levels in patients with AS increased significantly compared with those in UA and healthy volunteers; PAPP-A was significantly related with hs-CRP(r=0.308);using the method of multiple regression and correlation PAPP-A had linear relationship with hsCRP in all of the cases.Conclusion PAPP-A can play a role in evaluating the clinical stability of patients with coronary disease,and may serve as one of the biomarkers of vulnerable plaques.