目的 探讨血清糖原磷酸化酶BB(GPBB)在非ST段抬高急性冠脉综合征(non-ST-elevation acute coronary syndromes, NSTE ACS)中的诊断和预测价值。方法 检测83例不稳定型心绞痛(unstable angina pectoris, UAP)和72例非ST段抬高急性心肌梗死(non-ST-elevation acute myocardial infarction, NSTE AMI)患者血清GPBB和cTnI水平,应用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)比较两者对NSTE MI的诊断价值;同时随访比较98例NSTE ACS患者3年内发生主要心脏不良事件的情况。结果 NSTE MI组与UAP组GPBB值,胸痛发作6 h内分别为(7.364±5.452)μg/L和(1.118±0.860)μg/L,差异有统计学意义(P<0.01) ;12 h内分别为(8.045±4.934)μg/L和(0.849±0.589)μg/L,差异有统计学意义(P<0.01)。选择GPBB诊断NSTE MI的最佳cutoff值0.92 μg/L,cTnI的最佳cutoff值0.48 μg/L,此时胸痛发作6 h内GPBB曲线下面积0.845,敏感度77.8%,特异度75.9%;cTnI曲线下面积0.816,敏感度63.9%,特异度89.2%。胸痛发作12 h内GPBB曲线下面积0.912,敏感度84.7%,特异度91.6%;cTnI曲线下面积0.936,敏感度90.3%,特异度91.6%。高水平GPBB 的NSTE ACS患者较低水平者3年内更易于发生主要心脏事件。结论 GPBB对 NSTE MI的诊断具有较高敏感度,可辅助cTnI诊断NSTE MI,对NSTE ACS患者具有预后判断价值。

Objective To explore the diagnostic and prognostic value of glycogen phosphorylase BB(GPBB) in patients of non-ST elevation acute coronary syndromes(NSTE ACS).Methods Levels of GPBB and cTnI were measured in 83 patients with unstable angina pectoris(UAP) and 72 non-ST-elevation myocardial infarction (NSTE MI) before the data were analyzed with receiver operating characteristic curve(ROC curve) statistical software. Major adverse cardiac events were observed in 98 NSTE ACS patients after 3 years of follow-up.Results The GPBB value at 6h after chest pain of NSTE MI group and UAP group was 7.364±5.452 μg/L and 1.118±0.860 μg/L respectively, but was 8.045±4.934 μg/L and 0.849±0.589 μg/L respectively at 12h. The difference were statistically significant (P<0.001).The area under the ROC curve , sensitivity , and specificity of GPBB at 6h after chest pain when the optimal cutoff value was 0.92 μg/L in the diagnosis of NSTE MI were 0.845, 77.8% and 89.2% respectively, but were 0.912, 84.7% and 91.6% respectively at 12 h, while those of cTnI at 6 h after chest pain when the optimal cutoff value was 0.48 μg/L in the diagnosis of NSTE MI were 0.816, 63.9% and 89.2% respectively, but were 0.936, 90.3% and 91.6% respectively at 12 h. High GPBB had a strong association with the risk of major adverse cardiac events through 3 years of follow-up.Conclusions GPBB is a more sensitive marker of NSTE MI than cTnI at 6 h after chest pain and of clinical value for prognosis of NSTE ACS.