Heart：髓过氧化物酶水平可预测急性心梗预后

生物谷

    生物谷：七月出版的《心脏》杂志上有一篇报道说，髓过氧化物酶（MPO）水平有助于评定急性ST段抬高的心肌梗塞患者的预后。

    英国莱斯特大学的Sohail  Q．  Khan博士说，MPO可以用于找出有生命危险或者再次心梗的高危患者。通过识别出这些患者，他们希望能够修正他们的治疗，避免这些灾难性的不良后果。Khan博士及其同事对384名急性ST段抬高的心肌梗塞患者进行研究，看MPO能否增加急性心肌梗塞患者的预后评定，比较MPO的使用与N端前B型尿钠排泄肽（NT-BNP）的预后意义。结果发现，急性ST段抬高的心肌梗塞患者血浆MPO水平高于对照。与没有再次发生心梗的存活者相比，那些死亡或者再次心梗的患者MPO水平尤其高。研究的初步结果表明，中位MPO对数值和中位NT-BNP对数值是死亡或者心梗复发的独立预后因素。MPO水平不能独立预测死亡，非致死性心梗，或者心衰，而NT-BNP是死亡的独立预后指标。

    Khan博士说，MPO可用于对高危患者做进一步的危险度评定，危险度分级比目前使用的临床和生化危险预测指标如年龄、肾功能、肌钙蛋白和NT－BNP要好，也优于超声心动评价的射血分数。联合使用MPO和NT-BNP可以找出特别高危的患者。

    Khan博士说，他们正在进行一些研究，找新的标志，并试图找出急性心梗后新的神经体液途径。他们正在招募非ST段抬高的心梗患者，看我们的早期结果是否适合这些患者。（中国公众科技网）

原始出处:

Published Online First: 28 December 2006. doi:10.1136/hrt.2006.091041
Heart 2007;93:826-831
ACUTE CORONARY SYNDROMES

Myeloperoxidase aids prognostication together with N-terminal pro-B-type natriuretic peptide in high-risk patients with acute ST elevation myocardial infarction

Sohail Q Khan, Dominic Kelly, Paulene Quinn, Joan E Davies and Leong L Ng

Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK

Correspondence to:
Dr S Q Khan
Department of Cardiovascular Medicine, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, UK; sqk1@le.ac.uk

ABSTRACT
Background: Inflammation plays a critical role in acute myocardial infarction (MI). One such inflammatory marker is myeloperoxidase (MPO). Its role as a predictor of death or MI in patients with ST segment elevation myocardial infarction (STEMI) is unclear.

Aim: To investigate the role of MPO as a predictor of death or MI in patients with STEMI and to compare it with N-terminal pro-B-type natriuretic peptide (NT-BNP).

Method: 384 post STEMI patients were studied. Patients were followed up for the combined end point of death or readmission with non-fatal MI.

Results: There were 40 deaths and 37 readmissions with MI. Median MPO was raised in patients experiencing death or MI than in survivors (median (range), 50.6 (15.3–124.1) ng/ml vs 33.5 (6.6–400.2) ng/ml, p = 0.001). Using a Cox proportional hazards model, log median MPO (HR 6.91, 95% CI 1.79 to 26.73, p = 0.005) and log median NT-BNP (HR 4.21, 95% CI 1.53 to 11.58, p = 0.005) independently predicted death or non-fatal MI. MPO had predictive power in both below and above median NT-BNP levels (log rank 5.60, p = 0.020 and log rank 5.12, p = 0.024, respectively). The receiver-operating curve for median NT-BNP yielded an area under the curve (AUC) of 0.72 (95% CI 0.65 to 0.79, p<0.001); for median MPO, the AUC was 0.62 (95% CI 0.55 to 0.69, p = 0.001). The logistic model combining the two markers yielded an AUC of 0.76 (95% CI 0.69 to 0.82, p<0.001).

Conclusion: MPO and NT-BNP may be useful tools for risk stratification of all acute coronary syndromes, including patients with STEMI at higher risk.

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