Esporcatte Roberto, Rey Helena Cramer Veiga, Rangel Fernando Oswaldo Dias, Rocha Ricardo Mourilhe, Mendonça Filho Hugo Tannus Furtado de, Dohmann Hans Fernando Rocha, Albanesi Filho Francisco Manes
Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil.
Arq Bras Cardiol. 2007 Dec;89(6):377-84. doi: 10.1590/s0066-782x2007001800005.
Myeloperoxidase (MPO) is a highly expressed enzyme due to leukocyte activation, with multiple atherogenic actions, including LDL cholesterol oxidation, and is related to the instability of atherosclerotic plaque. It is a predictor of adverse events in healthy individuals, patients with heart disease or those undergoing chest pain investigations.
To analyze the contribution of MPO to identify patients with acute chest pain, non-ST elevation ECG and at high risk for in-hospital adverse events.
Patients presenting acute chest pain and a non-ST elevation ECG, were admitted to the hospital and submitted to serum MPO level measurements and a structured examination protocol.
From a cohort of 140 patients, 49 (35%) were diagnosed with acute coronary syndrome, of which 13 patients (9.3%) were diagnosed with non-ST elevation acute myocardial infarction (AMI) (troponin I >1.0 ng/mL). The best MPO cut-off point for AMI was identified as >100 pM using the ROC curve (AUC=0.662; CI 95%=0.532-0.793) revealing elevated sensitivity (92.3%) and negative predictive value (98.1%), however with low specificity (40.2%). In the multivariate analysis, MPO proved to be the only independent variable to diagnose AMI in evolution, with an odds ratio of 8.04 (p=0.048).
In patients with acute chest pain and no ST elevation, high MPO levels upon admission to the hospital are an important tool to predict in-hospital adverse events, with an odds ratio of eight for the diagnosis of AMI.
髓过氧化物酶（MPO）是一种因白细胞激活而高度表达的酶，具有多种致动脉粥样硬化作用，包括氧化低密度脂蛋白胆固醇，并且与动脉粥样硬化斑块的不稳定性相关。它是健康个体、心脏病患者或接受胸痛检查者不良事件的预测指标。
分析MPO在识别急性胸痛、非ST段抬高心电图且住院期间发生不良事件风险高的患者中的作用。
呈现急性胸痛且心电图为非ST段抬高的患者入院，并接受血清MPO水平测量及结构化检查方案。
在140例患者队列中，49例（35%）被诊断为急性冠状动脉综合征，其中13例（9.3%）被诊断为非ST段抬高急性心肌梗死（AMI）（肌钙蛋白I>1.0 ng/mL）。使用ROC曲线确定AMI的最佳MPO切点为>100 pM（AUC=0.662；95%CI=0.532 - 0.793），显示出较高的敏感性（92.3%）和阴性预测值（98.1%），但特异性较低（40.2%）。在多变量分析中，MPO被证明是诊断进展期AMI的唯一独立变量，并具有8.04的比值比（p=0.048）。
在急性胸痛且无ST段抬高的患者中，入院时MPO水平升高是预测住院期间不良事件的重要工具，诊断AMI的比值比为8。
