目的 探讨冠心病患者血浆妊娠相关蛋白A(PAPP-A)在冠心病危险分层中的临床意义.方法收集冠心病患者150例,其中稳定型心绞痛(SAP)组、不稳定心绞痛(UAP)组及急性心肌梗死(AMI)组各50例,选择同期冠脉造影正常的50例患者作为对照组,采用固相夹心酶联免疫法测定血浆PAPP-A的浓度;同时根据冠状动脉造影结果采用Gensini评分系统对冠心病患者进行评分.结果 (1) AMI组、UAP组PAPP-A浓度及Gensini积分均明显高于SAP组及对照组(P均<0.05);而SAP组与对照组比较差异无统计学意义(P>0.05).(2)血浆PAPP-A浓度与冠心病Gensini评分呈正相关(AMI组:r=0.80,P<0.01;UAP组:r=0.60,P<0.05;SAP组:r=0.54,P<0.05),而在对照组两者无相关性(r=0.20,P>0.05).结论 PAPP-A浓度与冠心病严重程度具有相关性,PAPP-A可作为判断冠心病严重程度的危险因素之一.%Objective To investigate the clinical significance of pregnancy associated plasma protein A ( PAPP-A ) in the risk stratification of coronary heart disease by determine the plasma PAPP-A of the coronary heart disease ( CHD ). Methods 150 CHD patients were enrolled, included stable angina pectoris ( SAP, n =50 ), unstable angina pectoris( UAP, n = 50 ) and acute myocardial infarction ( AMI, n = 50 ). The plasma levels of PAPP-A were detected in the method of enzyme linked immunosorbent assays. Meanwhile, the patients with coronary heart disease were scored with Gensini Score system based on coronary angiography. Results ( 1 ) The plasma concentration of UAP group and AMI group were obviously higher than in the SAP group and the normal controls, the difference was statistical significance( P <0. 05 ). ( 2 ) The plasma concentration of PAPP-A in patients with the CHD was positive correlated with the Gensini score ( AMI group: r =0. 80, P < 0.05;UAP group: r =0.60, P < 0.05; SAP group: r = 0. 54, P < 0. 05 ), while there was no correlation in control group ( r = 0. 20, P > 0. 05 ). Conclusion The plasma of PAPP-A is correlated with the serious degree of the CHD. It is used as an independent risk factor of the serious levels of the CHD.
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