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目的:探讨心肌梗死急性期血清新蝶呤(Neopterin,Npt)的变化及其预后判断价值。方法:以86例急性心肌梗死(AMI)患者为对象,与88例不稳定型心绞痛(UAP)、62例稳定型心绞痛(SAP)及35例健康者行对照观察。检测两组血Npt水平(AMI、UAP患者测定入院时、3d后和出院前3个时点,SAP与健康者为单次检测),记录AMI组住院及随访期间(11～13个月,平均11.2个月)心脏性死亡、再发性梗死、心绞痛等事件发生情况。结果:AMI组Npt阳性率及平均水平明显高于UAP、SAP及健康者(均P<0.01)。AMI患者入院时及3d后血Npt相似,均明显高于出院前(P<0.01)。血Npt阳性者,住院及随访期间心脏事件发生率显著高于Npt阴性者(P<0.05)。但有与无事件发生者,入院时、3d后、出院前3个时点血Npt水平比较,仅出院前差异有统计学意义(P<0.01)。经校正其他因素后,3个时点血Npt对AMI患者事件发生的相对危险度(95%可信区间)分别为4.7(0.6～36.3,P>0.05)、4.2(0.8～5.1,P>0.05)、7.2(1.8～29.6,P<0.01)。结论:AMI急性期血Npt明显升高,病情稳定后逐渐下降,此时的水平反映了不稳定斑块的炎症活动状况,是AMI患者预后的独立预测因子。
Objective: To investigate the change of serum neopterin (Neptin, Npt) in acute myocardial infarction and its prognostic value. Methods: A total of 86 patients with acute myocardial infarction (AMI) were enrolled and compared with 88 patients with unstable angina pectoris (UAP), 62 patients with stable angina (SAP) and 35 healthy controls. Blood Npt levels were measured in both groups (AMI, UAP patients were measured at admission, 3 days after discharge and at 3 points before discharge, SAP and healthy individuals were single test), and recorded during AMI hospitalization and follow-up (11-13 months, mean 11.2 months) cardiac death, recurrent infarction, angina and other events. Results: The positive rate and the average level of Npt in AMI group were significantly higher than those in UAP, SAP and healthy people (all P <0.01). The Npt levels of blood in patients with AMI at admission and after 3 days were significantly higher than those before discharge (P <0.01). Blood Npt positive, hospitalization and follow-up of cardiac events was significantly higher than Npt negative (P <0.05). However, there was no significant difference (P <0.01) between Npt levels at 3 hours before hospital discharge and 3 days after hospital admission, and only at the time of admission. After adjusting for other factors, the relative risk (95% confidence interval) of the three time point blood Npts in patients with AMI were 4.7 (0.6-36.3, P> 0.05), 4.2 (0.8-5.1, P> 0.05 ), 7.2 (1.8-29.6, P <0.01). CONCLUSIONS: During the acute phase of acute AMI, the blood Npt level is obviously increased, and then gradually decreases after the disease is stable. The level at this time reflects the inflammatory activity of unstable plaques and is an independent predictor of the prognosis of patients with AMI.