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目的探讨PAPP-A、hs-CRP是否可以作为评价ACS患者预后的血清学指标。方法本研究病例选自2008年9月至2010年8月在余姚人民医院内科住院并经冠脉造影证实为冠心病的患者82例。所有研究对象均于入院次日清晨采集空腹血,同步测定血清PAPP-A、hs-CRP含量。PAPP-A的测定采用酶联免疫吸附(enzyme linked immunosorbent assay,ELISA)法,hs-CRP测定采用免疫透射比浊法。结果所有研究对象在年龄、性别、高血压病史、吸烟史、糖尿病史、体重指数、血脂、血糖等基本临床资料方面差异无统计学意义(P>0.05)。应用受试者特征曲线(receiver operating characteristic curve,ROC)对PAPP-A、hs-CRP早期诊断ACS及评价12个月预后的情况进行分析,诊断ACS时PAPP-A、hs-CRP的ROC曲线下面积分别为0.860±0.049、0.763±0.049(均有P<0.01),PAPP-A诊断ACS的灵敏度为81.32%、特异度为82.14%,hs-CRP诊断ACS的灵敏度为74.36%、特异度为65.07%。结论 PAPP-A、hs-CRP是冠心病的独立危险因子,PAPP-A与hs-CRP对ACS患者早期诊断及12个月预后评价均有重要价值,前者的综合效率高于后者。
Objective To investigate whether PAPP-A and hs-CRP can be used as serological markers to evaluate the prognosis of patients with ACS. Methods The study cases were selected from 82 patients who were hospitalized in Yuyao People’s Hospital from September 2008 to August 2010 and confirmed by coronary angiography as coronary heart disease. Fasting blood was collected in all subjects on the morning of admission, and the serum levels of PAPP-A and hs-CRP were measured simultaneously. PAPP-A was detected by enzyme-linked immunosorbent assay (ELISA) and hs-CRP by immunoturbidimetry. Results All subjects had no significant difference in basic clinical data such as age, gender, history of hypertension, smoking history, history of diabetes, body mass index, blood lipids and blood glucose (P> 0.05). The receiver operating characteristic curve (ROC) was used to analyze the early diagnosis of ACS and evaluate the prognosis of PAPP-A and hs-CRP at 12 months. The ROC curves of PAPP-A and hs-CRP The sensitivity and specificity of PAPP-A in diagnosing ACS were 81.32% and 82.14% respectively. The sensitivity and specificity of hs-CRP in diagnosing ACS were 74.36% and 65.07, respectively %. Conclusions PAPP-A and hs-CRP are independent risk factors of coronary heart disease. PAPP-A and hs-CRP are of great value in the early diagnosis and prognosis evaluation of ACS patients. The former is more effective than the latter.