可溶性凝集素样氧化型低密度脂蛋白受体-1 作为 ST 段抬高型心肌梗死的早期生物标志物：与其他生物标志物的时间依赖性比较：与其他生物标志物的时间依赖性比较。

Soluble lectin-like oxidized low-density lipoprotein receptor-1 as an early biomarker for ST elevation myocardial infarction: time-dependent comparison with other biomarkers: time-dependent comparison with other biomarkers.

机构信息

Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Inzai, Chiba 270-1694, Japan.

出版信息

Circ J. 2011;75(6):1433-9. doi: 10.1253/circj.cj-10-0913. Epub 2011 Mar 30.

DOI:10.1253/circj.cj-10-0913

PMID:21467660

Abstract

BACKGROUND

The diagnostic sensitivity of myocardial necrosis markers, such as creatine kinase-MB (CK-MB), cardiac troponins, myoglobin and heart-type fatty acid-binding protein (H-FABP) for the earliest stage of ST-elevation myocardial infarction (STEMI), remains insufficient. We compared a new biomarker of plaque vulnerability (soluble lectin-like oxidized low-density lipoprotein receptor-1, sLOX-1) with other biomarkers at the earliest stage of STEMI.

METHODS AND RESULTS

Plasma sLOX-1 levels were measured in 125 STEMI, 44 non-STEMI (NSTEMI) and 125 non-acute myocardial infarction (non-AMI) patients and were significantly (P < 0.0001) higher in the STEMI and NSTEMI than in the non-AMI patients (median, 25th and 75th percentiles: 241.0, 132.3 and 472.2 vs. 147.3, 92.9 and 262.4 vs. 64.3, 54.4 and 84.3 pg/ml, respectively). At the optimal cut-off value of 91.0 pg/ml, sLOX-1 discriminated STEMI from non-AMI with 89.6% sensitivity and 82.4% specificity. Time-dependent changes in sLOX-1, H-FABP, myoglobin, troponin T and CK-MB were analyzed in 27 STEMI patients. Elevated plasma sLOX-1 levels persisted for 24h after admission, whereas other markers were not elevated at the time of admission and peaked at ≥ 2h thereafter. The diagnostic sensitivity of sLOX-1, H-FABP, myoglobin, troponin T and CK-MB for STEMI upon admission (89 min after onset) was 93%, 78%, 70%, 56% and 33%, respectively.

CONCLUSIONS

Plasma sLOX-1 diagnosed the early stages of STEMI more accurately than H-FABP, myoglobin, troponin T and CK-MB.

摘要

背景

肌酸激酶同工酶-MB（CK-MB）、心脏肌钙蛋白、肌红蛋白和心脏型脂肪酸结合蛋白（H-FABP）等心肌坏死标志物对 ST 段抬高型心肌梗死（STEMI）的早期诊断灵敏度仍不足。我们比较了一种新的斑块脆弱性生物标志物（可溶性凝集素样氧化低密度脂蛋白受体-1，sLOX-1）与其他生物标志物在 STEMI 的早期阶段的表现。

方法和结果

测定了 125 例 STEMI、44 例非 ST 段抬高型心肌梗死（NSTEMI）和 125 例非急性心肌梗死（非 AMI）患者的血浆 sLOX-1 水平，STEMI 和 NSTEMI 患者的 sLOX-1 水平明显高于非 AMI 患者（中位数、25%和 75%分位数：241.0、132.3 和 472.2 比 147.3、92.9 和 262.4 比 64.3、54.4 和 84.3pg/ml）。在最佳截断值 91.0pg/ml 时，sLOX-1 对 STEMI 的诊断敏感度为 89.6%，特异度为 82.4%。对 27 例 STEMI 患者进行了 sLOX-1、H-FABP、肌红蛋白、肌钙蛋白 T 和 CK-MB 的时间依赖性变化分析。入院后 24h 内，血浆 sLOX-1 水平持续升高，而其他标志物在入院时未升高，且在≥2h 后达到峰值。入院时（发病后 89 分钟）sLOX-1、H-FABP、肌红蛋白、肌钙蛋白 T 和 CK-MB 对 STEMI 的诊断敏感度分别为 93%、78%、70%、56%和 33%。