作者：逄帅 吕文辉 李大鹏 刘成玉
【摘要】 目的 探讨冠心病（CHD）病人血清可溶性糖蛋白130（sgp130）和超敏C反应蛋白（hs?CRP）的变化及其临床意义。方法 采用ELISA和散射速率比浊法检测了20例急性心肌梗死（AMI）病人、20例不稳定型心绞痛（UAP）病人、20例稳定型心绞痛（SAP）病人血清sgp130、hs?CRP水平的变化，并与20例健康体检者（对照组）进行比较。结果 CHD病人血清sgp130水平明显降低，血清hs?CRP水平明显增高，与对照组比较，差异有显著性（t=6.97、6.86，P＜0.01）。AMI、UAP及SAP病人sgp130和hs?CRP水平比较，差异有显著性（F=47.14、36.23，q=4.26-15.66，P＜0.01）。AMI病人血清sgp130、hs?CRP水平均低于或高于UAP病人、SAP病人和对照组（q=4.59-15.66，P＜0.01）；UAP病人血清sgp130、hs?CRP水平显著低于或高于SAP病人和对照组（q=4.26-11.06，P＜0.01）；SAP病人血清sgp130水平与对照组之间亦有统计学差异（q=4.93，P＜0.01）。CHD病人血清sgp130与hs?CRP水平呈负相关（r=－0.574，P＜0.01）。血清sgp130、hs?CRP水平在AMI、UAP组AUCROC均大于0.90，对AMI诊断的灵敏度和特异度分别为0.95、0.90和0.90、0.95，对UAP诊断的灵敏度和特异度分别为0.95、0.90和0.90、0.95。结论 血清sgp130、hs?CRP浓度的变化对AMI和UAP具有较高的诊断准确度，其变化的程度可以作为炎症反应和病情严重的判断指标之一。
【关键词】 冠状动脉疾病；糖蛋白类；C反应蛋白；诊断
［ABSTRACT］ Objective To explore the clinical significance of changes in serum levels of soluble glycoprotein?130 (sgp130) and hypersensitive C?reactive protein (hs?CRP) in patients with coronary heart disease (CHD). Methods By using enzyme?linked immunosorbent assay (ELISA) and light scattering rate nephelometry method, levels of sgp130 and hs?CRP were measured in 20 patients with acute myocardial infarction (AMI), 20 unstable angina pectoris (UAP), and 20 stable angina pectoris (SAP). The results were compared with that of 20 healthy controls. Results The serum sgp130 was lower, and hs?CRP higher in patients with CHD than that in the controls (t=6.97,6.86;P<0.01). Significant differences in serum levels of sgp130 and hs?CRP were noticed among the AMI, UAP and SAP patients (F=47.14,36.23;q=4.26-15.66;P<0.01). The serum sgp130 and hs?CRP in patients with AMI were lower or higher than that of UAP, SAP and the controls (q=4.59-15.66,P<0.01); and that in patients with UAP were much lower or higher than that of patients with the SAP and the controls (q=4.26-11.06,P<0.01); and the difference of the levels of sgp130 in patients between SAP and the controls were significant (q=4.93,P<0.01). The level of sgp130 was negatively correlated with hs?CRP in patients with CHD (r=-0.574,P<0.01). The areas under the ROC curve (AUCROC) were all greater than 0.9 with higher sensitivity and specificity. The sensitivity and specificity of sgp130 and hs?CRP were 0.95/0.90 and 0.90/0.95 in patients with AMI. The sensitivity and specificity of sgp130 and hs?CRP were 0.95/0.90 and0.90/0.95 in patients with UAP. Conclusion The changes in levels of sgp130 and hs?CRP have higher accuracy on the diagnosis of AMI and UAP, which can be used as one of the indexes for judgement of inflammation and severity of coronary heart disease.