朱汉华,阳维德,郑萍,黄晓明,罗秀峰,潘宏彬,陈锋,王新云,马小燕

• 1:广西壮族自治区南溪山医院心内科
• 2:广西壮族自治区南溪山医院检验科

摘要(Abstract)：

目的探讨急性心肌梗死患者血清妊娠相关蛋白-A(PAPP-A)水平与全球急性冠状动脉事件注册(GRACE)评分对随访期间主要不良心血管事件(MACE,包括心源性死亡和再次心肌梗死)的预测价值。方法前瞻性连续纳入2011年7月至2015年7月在广西南溪山医院心血管内科住院明确诊断为急性心肌梗死的患者220例,入院时静脉抽取血清PPAP-A,计算GRACE评分,记录住院及随访期间患者MACE发生情况。结果 (1)分别以血清PAPP-A水平、GRACE评分危险分层作为检验变量,以患者随访期间MACE发生情况作为状态变量,绘制ROC曲线。根据血清PAPP-A水平分层ROC曲线下面积为0.796(95%CI 0.696~0.896,P<0.01),PAPP-A界值为3 ng/ml,敏感度为77.8%,特异度为76.5%。根据GRACE评分危险分层ROC曲线下面积为0.715(95%CI0.567~0.863,P<0.01),GRACE评分界值为140,敏感度为75.9%,特异度为74.5%。(2)平均随访时间(13.2±1.3)个月。PAPP-A≥3.0 ng/ml组发生心源性死亡8例,再发心肌梗死3例;PAPP-A<3.0 ng/ml组发生心源性死亡8例,再发心肌梗死1例。Kaplan-Meier生存分析结果显示,PPAP-A≥3.0 ng/ml组随访期间MACE高于PPAP-A<3.0 ng/ml组(15.7%比6.0%,log-rank检验χ2=5.684,P=0.017)。(3)在GRACE评分高危组,PAPP-A≥3.0 ng/ml组,6例发生MACE,PPAP-A<3.0 ng/ml组,6例发生MACE,其无MACE生存率比较,差异无统计学意义(26.1%比25.0%,log-rank检验χ2=3.885,P=0.090)。在GRACE评分中低危组,PAPP-A≥3.0 ng/ml组,5例发生MACE,PPAP-A<3.0 ng/ml组,3例发生MACE,其无MACE生存率比较,差异有统计学意义(10.8%比2.3%,log-rank检验χ2=14.63,P<0.001)。结论血清PAPP-A水平在预测急性心肌梗死患者随访期间心源性死亡和再发心肌梗死,有较好的预测价值,尤其在GRACE评分中低危患者中,血清PAPP-A水平更高者,MACE发生率更高。

关键词(KeyWords)： 血清妊娠相关蛋白-A;全球急性冠状动脉事件注册评分;急性心肌梗死;预后

Abstract:

Keywords:

基金项目(Foundation): 广西医疗卫生重点科研课题(重2011020)

作者(Author): 朱汉华,阳维德,郑萍,黄晓明,罗秀峰,潘宏彬,陈锋,王新云,马小燕

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