cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1252Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMАссоциированный с беременностью протеин плазмы – новый биохимический маркер острого коронарного синдрома и предиктор неблагоприятного прогноза у больных ишемической болезнью сердцаPregnancy-associated plasma protein – a new biochemical marker of acute coronary syndrome and poor prognosis predictor in coronary heart disease patientsШевченкоО. П.ShevchenkoO. P.ШевченкоА. О.ShevchenkoA. O.КочетоваЕ. В.KochetovaE. V.Elena@kochetoff.comОрловаО. В.OrlovaO. V.Российский государственный медицинский университет; Клиническая больница Управления делами Президента Российской ФедерацииRussian State Medical University; Clincial Hospital, Russian Federation President Affairs AdministrationНИИ трансплантологии и искусственных органов. МоскваReseach Institute of Transplantology and Artificial Organs. Moscow20062008200654110116Copyright © Шевченко О.П., Шевченко А.О., Кочетова Е.В., Орлова О.В., 20062006Шевченко О.П., Шевченко А.О., Кочетова Е.В., Орлова О.В.Shevchenko O.P., Shevchenko A.O., Kochetova E.V., Orlova O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1252

Введение. Ассоциированный с беременностью протеин плазмы (PAPP-A) является цинксодержащей металлопротеиназой, активирующей инсулиноподобный фактор роста. Повышение уровней PAPPA отмечается при остром коронарном синдроме (ОКС) и при различных патологических состояниях, сопровождающихся воспалительно-деструктивными изменениями. Цель. Изучить содержание PAPP-A в крови больных с разными формами ишемической болезни сердца (ИБС) и его связь с двухлетним прогнозом. Материал и методы. В исследование включены 75 лиц в возрасте 62,3±10,1 лет: 17 больных инфарктом миокарда (ИМ), 23 больных нестабильной стенокардией (НС), 24 пациента со стенокардией напряжения, 11 здоровых лиц. Период наблюдения составил 2 года; оценивались конечные точки (КТ): смерть, ИМ, НС и прогрессирование сердечной недостаточности (СН). Помимо рутинных клинических исследований, у всех определялись уровни РАРР-А, интерлейкина-6 (ИЛ-6) и С-реактивного белка (СРБ) при помощи высокочувствительных иммуноферментных методов. Результаты. Уровни РАРР-А достоверно коррелировали с концентрацией СРБ (r=0,361; р=0,043) и ИЛ-6 (r=0,387; р=0,035). Содержание PAPP-A, ИЛ-6 и СРБ в крови здоровых лиц и у больных стенокардией напряжения достоверно не отличалось. По сравнению с больными стенокардией напряжения, у больных НС повышены уровни PAPP-A – 8,6±6,7 vs 14,4±9,5 мМЕ/л (p<0,05) и СРБ – 4,5±4,0 vs 7,3±5,5 мг/л (p<0,05). У больных ИБС с PAPP-A<10 мМЕ/л (n=32) КТ отмечены у 4, в то время как у больных с PAPPA>10 мМЕ/л (n=32) КТ имели место у 11 больных; средняя продолжительность периода до наступления КТ составила 1030±52 и 656±51 дней, соответственно (p<0,05). Сравнение выживаемости без КТ при помощи логрангового метода показало, что прогноз у больных с PAPP-A<10 мМЕ/л достоверно лучше, чем у больных с PAPP-A>10 мМЕ/л (p=0,047). Заключение. PAPP-A является маркером, участвующим в патогенезе ИБС; уровни его в крови кореллируют с выраженностью системного воспаления, повышены у больных с ОКС; у больных с более высокими уровнями PAPP-A отмечается менее благоприятный прогноз.

Background. Pregnancy-associated plasma protein (PAPP-A) is Zn-containing proteinase, activating insulin-like growth factor. PAPP-A level increase is observed in acute coronary syndrome (ACS) and other inflammatory and destructive pathology. Aim. To investigate PAPP-A blood levels in patients with various forms of coronary heart disease (CHD), and their link to two-year prognosis. Material and methods. The study included 75 patients aged 62.3±10.1 years: 17 individuals with myocardial infarction (MI), 23 participants with unstable angina (UA), 24 patients with effort angina, and 11 healthy volunteers. The follow-up lasted for two years. End-points (EP) included death, MI, UA, and heart failure (HF) progression. Besides routine clinical tests, the levels of PAPP-A, interleukin-6 (IL-6), and C-reactive protein (CRP) were measured by highly sensitive immuno-enzyme methods. Results. PAPP-A levels significantly correlated with CRP (r=0.361; р=0.043) and IL-6 concentration (r=0.387; р=0.035). PAPP-A, IL-6, and CRP blood levels were similar in healthy volunteers and SA patients. Comparing to SA patients, UA participants had increased levels of PAPP-A (8.6±6.7 vs 14.4±9.5 mIU/l; p<0.05) and CRP (4.5±4.0 vs 7.3±5.5 mg/l; p<0.05). In CHD patients with PAPP-A level <10 mIU/l (n=32), EP were registered in 4 cases. Among patients with PAPP-A levels >10 mIU/l (n=32), EP were registered in 11 participants. Mean time till EP registration was 1030±52 and 656±51 days, respectively (p<0.05). Comparing EP-free survival (logrange method), it was demonstrated that prognosis was better in subjects with PAPP-A levels <10 mIU/l, than in participants with PAPP-A levels >10 mIU/l (p=0.047). Conclusion. PAPP-A is a marker participating in CHD pathogenesis. Its blood levels correlated with systemic inflammation severity, being elevated in ACS patients. Patients with higher PAPP-A levels had poorer prognosis.

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The authors declare that there are no conflicts of interest present.