Gururajan P, Gurumurthy P, Nayar P, Babu S, Sarasabharati A, Victor D, Cherian K M
International Centre for Cardiothoracic and Vascular Diseases, Department of Biochemistry, Dr KM Cherian Heart Foundation (a unit of Frontier LifeLine Pvt Ltd) Mogappair, Chennai, India.
Department of Cardiology, Chettinad Hospital and Research Institute, Kelambakkam, India.
Heart Asia. 2009 Jan 1;1(1):41-6. doi: 10.1136/ha.2009.000778. eCollection 2009.
Myeloperoxidase, an abundant leucocyte enzyme, is elevated in culprit lesions that have ruptured in patients with sudden cardiac injury. Multiple lines of evidence suggest an association between myeloperoxidase and inflammation and acute coronary syndrome. Myeloperoxidase has been proposed as a potent risk marker and diagnostic tool in acute coronary syndrome (ACS). Recent studies have reported the potential use of myeloperoxidase in acute coronary syndrome, but limited reports are available on its utility in different groups of ACS in the emergency department. Therefore the circulating levels of serum myeloperoxidase in patients with acute coronary syndrome and control subjects were studied.
The levels of serum myeloperoxidase were measured by ELISA in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as non-cardiac chest pain (NCCP). The levels of myeloperoxidase were significantly increased in patients with ACS when compared with controls and NCCP. From the receiver operator characteristic (ROC) curve analysis, the optimum value above which myeloperoxidase can be considered positive was found to be 48.02 U/ml. The area under the curve was found to be 0.956 with 95% CI (0.934 to 0.973) (p<0.0001). A combination analysis of ROC curves of troponin, creatine kinase MB (CK-MB) and myeloperoxidase showed myeloperoxidase to be highly significant. Multivariate analysis revealed myeloperoxidase to be an independent diagnostic marker for early diagnosis of ACS.
Myeloperoxidase, in contrast to troponin and CK-MB, identified patients at risk of ischaemic events, even in the absence of myocardial necrosis, thus highlighting its potent usefulness for risk stratification among patients presenting with chest pain.
髓过氧化物酶是一种在白细胞中含量丰富的酶，在心脏急性损伤患者发生破裂的罪犯病变中水平升高。多条证据表明髓过氧化物酶与炎症及急性冠状动脉综合征之间存在关联。髓过氧化物酶已被提议作为急性冠状动脉综合征（ACS）的一种强效风险标志物和诊断工具。近期研究报道了髓过氧化物酶在急性冠状动脉综合征中的潜在用途，但关于其在急诊科不同ACS亚组中的效用的报道有限。因此，对急性冠状动脉综合征患者和对照受试者的血清髓过氧化物酶循环水平进行了研究。
采用酶联免疫吸附测定法（ELISA）检测了485名入住急诊监护病房患者的血清髓过氧化物酶水平，其中89名患者被诊断为非心源性胸痛（NCCP）。与对照组和NCCP患者相比，ACS患者的髓过氧化物酶水平显著升高。通过受试者操作特征（ROC）曲线分析，发现髓过氧化物酶可被视为阳性的最佳值为48.02 U/ml。曲线下面积为0.956，95%置信区间为（0.934至0.973）（p<0.0001）。肌钙蛋白、肌酸激酶MB（CK-MB）和髓过氧化物酶的ROC曲线联合分析显示髓过氧化物酶具有高度显著性。多变量分析显示髓过氧化物酶是ACS早期诊断的独立诊断标志物。
与肌钙蛋白和CK-MB不同，髓过氧化物酶能够识别有缺血事件风险的患者，即使在没有心肌坏死的情况下也是如此，从而突出了其在胸痛患者风险分层中的强大效用。
