CAJ | 학술논문

目的：建立双向侧流免疫髓过氧化物酶（ MPO）参考区间，确定MPO对AMI的最佳诊断cut-off值，评价MPO对AMI患者的早期诊断价值，同时观察MPO水平与AMI预后的关系。方法用双向侧流MPO检测试剂测定来自吉林大学第一医院体检中心健康体检人群363例血浆MPO浓度（对照组），363例健康人按照年龄分为＜30岁、30～39岁、40～49岁、50～59岁、60～69岁、≥70岁6组，按不同性别和年龄段进行统计分析，找出其参考区间。检测心肌梗死（ AMI）组、不稳定心绞痛（ UAP）组血浆中MPO浓度，通过ROC曲线找出MPO诊断AMI的最佳cut-off值。对AMI组MPO高水平患者进行电话随访，追踪MPO与AMI预后的关系。结果 MPO测定结果呈偏态分布，MPO水平在不同性别、各年龄组差异无统计学意义，故取单侧95百分位值为双向侧流免疫MPO参考区间，为小于23．10 ng/mL；AMI组和UAP组MPO高于对照组，AMI组高于UAP组（ P均＜0．01）。 MPO的ROC曲线下面积为0．761，对AMI最佳诊断cut-off值为28．82 ng/mL；在219例AMI组患者中，MPO阳性率0．808，cTnI阳性率0．653，其中MPO阳性而cTnI阴性的有50例。随访到AMI组MPO高水平患者81例，半年内15例再次发作AMI，其中3例死亡。结论双向侧流MPO参考区间为＜23．10 ng/mL，MPO对AMI最佳诊断cut-off值为28．82 ng/mL。MPO对AMI危险事件发生有早期提示价值，MPO增高可能是随后的1～6个月内发生严重心血管疾病危险性的独立指标，尤其是对cTnI假阴性患者更有意义。
목적：건립쌍향측류면역수과양화물매（ MPO）삼고구간，학정MPO대AMI적최가진단cut-off치，평개MPO대AMI환자적조기진단개치，동시관찰MPO수평여AMI예후적관계。방법용쌍향측류MPO검측시제측정래자길림대학제일의원체검중심건강체검인군363례혈장MPO농도（대조조），363례건강인안조년령분위＜30세、30～39세、40～49세、50～59세、60～69세、≥70세6조，안불동성별화년령단진행통계분석，조출기삼고구간。검측심기경사（ AMI）조、불은정심교통（ UAP）조혈장중MPO농도，통과ROC곡선조출MPO진단AMI적최가cut-off치。대AMI조MPO고수평환자진행전화수방，추종MPO여AMI예후적관계。결과 MPO측정결과정편태분포，MPO수평재불동성별、각년령조차이무통계학의의，고취단측95백분위치위쌍향측류면역MPO삼고구간，위소우23．10 ng/mL；AMI조화UAP조MPO고우대조조，AMI조고우UAP조（ P균＜0．01）。 MPO적ROC곡선하면적위0．761，대AMI최가진단cut-off치위28．82 ng/mL；재219례AMI조환자중，MPO양성솔0．808，cTnI양성솔0．653，기중MPO양성이cTnI음성적유50례。수방도AMI조MPO고수평환자81례，반년내15례재차발작AMI，기중3례사망。결론쌍향측류MPO삼고구간위＜23．10 ng/mL，MPO대AMI최가진단cut-off치위28．82 ng/mL。MPO대AMI위험사건발생유조기제시개치，MPO증고가능시수후적1～6개월내발생엄중심혈관질병위험성적독립지표，우기시대cTnI가음성환자경유의의。
Objective To established bidirectional lateral flow immune Myeloperoxidase ( MPO) reference range, de-termine the best diagnostic cut-off value MPO for AMI, evaluate MPO early diagnostic value of patients with AMI, investi-gate the relationship between levels of MPO and prognosis of AMI.Methods Totally 363 health cases were collected from the first hospital of Jilin university medical examination center; all of the 363 plasma specimen MPO concentrations were measured by MPO kits.363 cases of healthy people by age are divided into 6 groups which included less then 30, 30-39, 40-49, 50-59, 60-69 and at the age of 70 or higher.According to the different gender and age, statistical analysis was to execute.The plasma MPO levels of Acute Myocardial Infarction ( AMI) group, Unstable Angina Pectoris ( UAP) group and control group are tested by the MPO kits.The measurement results were statistically analyzed using ROC curves.The patients with high MPO level in AMI group were followed-up by telephone, tracking the relationship between MPO and the prognosis of AMI.Results There was no statistically significant difference of MPO levels in different gender and age groups which was due to the measurement results of MPO skew distribution, taking unilateral 95 percentile values for bidi-rectional lateral flow immune MPO reference range, which is less than 23.10 ng/mL; There were obvious differences of MPO ( P<0.01) which were compared among AMI group and UAP group and control, respectively;the comparison results between AMI group and UAP group were show significant differences (all P<0.01) as well.MPO in the area under the ROC curve is 0.761 and the best diagnosis of AMI cut-off value was 28.82 ng/mL.The positive rate of MPO was 0.808 and of cTnI is 0.653 in the 219 cases of AMI patients, separately.There were 50 cases with MPO positive but with cTnI negative.Totally 81 cases of patients with high MPO level were found, 15 cases had a relapse in a half years after the onset of AMI.and 3 cases died.Conclusion Bidirectional lateral flow MPO reference range was less than 23.10 ng/mL, and the best diagnosis of AMI cut-off values was 28.82 ng/mL.MPO has more clinical value for the early diagnosis of AMI. The increase of MPO may be an independent predictor of the risk of serious cardiovascular disease during the follow-up in-teral from one to six months later and it could be more meaningful to the patients especially whose cTnI are false negative.