Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, University of Minnesota School of Medicine and Minneapolis Medical Research Foundation, Minneapolis, MN 55415, USA.
Clin Chem. 2011 Apr;57(4):603-8. doi: 10.1373/clinchem.2010.158014. Epub 2011 Jan 24.
We assessed the ability of myeloperoxidase (MPO) to identify the risk for major adverse cardiac events (MACE) in patients who present with ischemic symptoms suggestive of acute coronary syndrome and have a normal cardiac troponin I (cTnI) value.
We used Siemens (n = 400) and Abbott (n = 350) assays to measure MPO and cTnI in plasma samples from 400 patients. Event rates (myocardial infarction, cardiac death, percutaneous coronary intervention, coronary artery bypass grafting) were estimated by the Kaplan-Meier method and compared with the log-rank statistic.
At the 30-day follow-up, the adjusted hazard ratios for MACE were 3.9 (P < 0.001) for increased cTnI and 2.7 (P = 0.006) for increased MPO for the Siemens assays and were 5.5 (P < 0.001) for increased cTnI and 2.9 (P = 0.001) for increased MPO for the Abbott assays. Similar findings were observed with 6 months of follow-up. Patients who initially had a normal cTnI value and an increased Siemens MPO value demonstrated a higher rate of MACE at 30 days than those in whom both values were normal (16.1% vs 3.6%, P = 0.002) and 6 months (18.1% vs 5.0%, P = 0.002). Similarly, patients who had an increased Abbott MPO result demonstrated a higher MACE rate at 30 days (12.3% vs 3.9%, P = 0.03) and at 6 months (16.2% vs 5.1%, P = 0.01) than those with normal values.
A combination of MPO and cTnI allowed the identification of a greater proportion of patients at risk for MACE than the use of cTnI alone. Increased MPO values remained predictive of future cardiac events even when the cTnI value was normal.
我们评估了髓过氧化物酶（MPO）在出现提示急性冠脉综合征的缺血症状且心肌肌钙蛋白 I（cTnI）值正常的患者中识别主要不良心脏事件（MACE）风险的能力。
我们使用西门子（n=400）和雅培（n=350）检测试剂盒测量了 400 名患者的血浆样本中的 MPO 和 cTnI。通过 Kaplan-Meier 方法估计事件发生率（心肌梗死、心脏死亡、经皮冠状动脉介入治疗、冠状动脉旁路移植术），并通过对数秩检验进行比较。
在 30 天随访时，对于西门子检测试剂盒，cTnI 升高的调整后的危险比为 3.9（P<0.001），MPO 升高的为 2.7（P=0.006）；对于雅培检测试剂盒，cTnI 升高的为 5.5（P<0.001），MPO 升高的为 2.9（P=0.001）。在 6 个月随访时也观察到了类似的发现。最初 cTnI 值正常但西门子 MPO 值升高的患者在 30 天内发生 MACE 的比率高于那些两项值均正常的患者（16.1%比 3.6%，P=0.002）和 6 个月时（18.1%比 5.0%，P=0.002）。同样，Abbott 检测试剂盒中 MPO 结果升高的患者在 30 天（12.3%比 3.9%，P=0.03）和 6 个月（16.2%比 5.1%，P=0.01）时发生 MACE 的比率高于 cTnI 值正常的患者。
与单独使用 cTnI 相比，MPO 和 cTnI 的组合可以识别出更多有发生 MACE 风险的患者。即使 cTnI 值正常，升高的 MPO 值仍可预测未来的心脏事件。
