血清BNP、hs-CRP联合24h动态心电图对老年冠状动脉性心脏病并发无症状心肌缺血的诊断价值

Diagnostic Value of Serum BNP and hs-CRP Combined with 24h Dynamic Electrocardiogram in Elderly Patients with Coronary Heart Disease Complicated with Asymptomatic Myocardial Ischemia

目的分析血清B型钠尿肽(B-type natriuretic peptide,BNP)、超敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)联合24 h动态心电图对老年冠状动脉性心脏病(简称"冠心病")并发无症状心肌缺血的诊断价值。方法连续收集2019年1月至2020年11月在中山市人民医院进行治疗的87例疑似老年冠心病并发无症状心肌缺血患者的临床资料。所有患者均进行血清BNP、hsCRP检测和24 h动态心电图检查,并以冠状动脉造影(coronary angiography,CAG)诊断为"金标准",根据检查结果分为CAG阳性组(n=61)和CAG阴性组(n=26),分析血清BNP、hs-CRP联合24 h动态心电图的临床诊断价值。结果CAG阳性组患者血清BNP、hs-CRP水平及心肌缺血发作持续时间较CAG阴性组明显升高(P<0.05);CAG阳性组ST段压低共阵158次,CAG阴性组ST段压低共阵451次,发作时间集中在6:01-12:00时间段,2组的心肌缺血ST段压低发作时间分布比较无明显差异(P>0.05);受试者工作特征曲线分析结果显示,血清BNP、hs-CRP及24 h动态心电图联合检测的诊断效能最大:曲线下面积0.859,敏感度0.923,特异性0.918,95%CI:0.758~0.960。结论血清BNP、hs-CRP联合24 h动态心电图提高了对老年冠心病并发无症状心肌缺血患者的诊断准确率,有助于早期筛查,可为临床诊断和治疗方案的制定提供一定的理论依据。

Objective To analyze the diagnostic value of serum B-type natriuretic peptide(BNP)and high-sensitivity C-reactive protein(hs-CRP)combined with 24 h dynamic electrocardiogram in the elderly patients with coronary heart disease complicated with asymptomatic myocardial ischemia.Methods The clinical data of 87 elderly patients with suspected coronary heart disease complicated with asymptomatic myocardial ischemia who were treated in Zhongshan People’s Hospital from January 2019 to November 2020 were continuously collected.All patients were tested for serum BNP,hs-CRP and 24 h dynamic electrocardiogram.Taking coronary angiography(CAG)as the golden standard.They were divided into CAG positive group(n=61)and CAG negative group(n=26)according to the examination results.The clinical diagnostic value of serum BNP and hs-CRP combined with 24 h dynamic electrocardiogram was analyzed.Results The levels of serum BNP and hs-CRP,and duration of myocardial ischemia onset in CAG positive group were significantly higher than those in CAG negative group(P<0.05).There were 158 times and 451 times of ST segment depression in CAG positive group and CAG negative group,respectively.The onset time was concentrated in the period of 06:01-12:00.There was no significant difference in the onset time of ST segment depression between the two groups(P>0.05).ROC curves analysis showed that diagnostic efficiency of serum BNP combined with hs-CRP and 24 h dynamic electrocardiogram was the greatest(AUC:0.859,sensitivity:0.923,specificity:0.918,95%CI:0.758-0.960).Conclusion The combination of serum BNP,hs-CRP and 24 h dynamic electrocardiogram improves the diagnostic accuracy rate of elderly patients with coronary heart disease complicated with asymptomatic myocardial ischemia,which is conductive to the early screening,and provides certain theoretical basis for the formulation of clinical diagnosis and treatment plans.