血清Lp-PLA2、IMA联合心电图诊断无症状性心肌缺血价值

Value of serum Lp-PLA2 and IMA combined with electrocardiogram in diagnosis of asymptomatic myocardial ischemia

目的探究血清脂蛋白相关磷脂酶A2(Lp-PLA2)、缺血修饰白蛋白(IMA)联合心电图诊断无症状性心肌缺血的价值。方法选择2017年1月至2019年11月在上海市青浦区中医医院收治的冠心病患者75例(观察组),其中男性33例,女性42例;年龄30~83岁,平均年龄61.61岁;无症状性心肌缺血54例,有症状性心肌缺血21例。同期体检54例健康者作为对照组,其中男性25例,女性29例;年龄35~85岁,平均年龄61.85岁。检测两组Lp-PLA2、IMA水平并进行心电图检测,分析其对无症状性心肌缺血诊断价值。结果观察组Lp-PLA2[无症状性心肌缺血(309.24±84.99)μg/L、有症状性心肌缺血(264.56±74.52)μg/L]、IMA[无症状性心肌缺血(104.21±33.90)kU/L、有症状性心肌缺血(87.41±25.58)kU/L]水平高于对照组[(158.63±32.84)μg/L、(68.05±15.99)kU/L],差异有统计学意义(P<0.05);且无症状性心肌缺血患者Lp-PLA2、IMA水平高于与有症状性心肌缺血患者,差异有统计学意义(P<0.05)。无症状性心肌缺血组心率变化高于有症状性心肌缺血组,而ST段下降幅度、缺血持续时间少于有症状性心肌缺血组,差异有统计学意义(P<0.05)。根据Lp-PLA2、IMA、心电图构建诊断无症状性心肌缺血受试者工作特性(ROC)曲线,三者联合检测曲线下面积、灵敏度、特异度、约登指数(0.959、98.1%、85.7%、0.857)均高于单纯Lp-PLA2(0.802、88.9%、71.4%、0.603)、IMA(0.751、64.8%、81.0%、0.458)、心电图检测(0.822、87.0%、76.2%、0.632)。结论Lp-PLA2、IMA联合心电图诊断无症状性心肌缺血具有较高的灵敏度和特异度,且无症状性心肌缺血患者中Lp-PLA2、IMA水平升高,心电图变化明显。因此三者联合检测可有效诊断无症状性心肌缺血。

Objective To explore the value of serum lipoprotein-related phospholipase A2(Lp-PLA2),ischemia modified albumin(IMA)combined with electrocardiogram(ECG)in diagnosis of asymptomatic myocardial ischemia.Methods From January 2017 to November 2019,75 patients with coronary heart disease(observation group)were enrolled,which included 33 males and 42 females,aged 30-83 years old with mean age of 61.61 years old;among them 54 cases were asymptomatic myocardial ischemia and 21 cases of symptomatic myocardial ischemia.Fifty-four healthy subjects were set as control group,which included 25 males and 29 females,aged 35-85 years old with mean age of 61.85 years old.The Lp-PLA2,IMA levels and ECG were detected and analyzed for diagnostic value of asymptomatic myocardial ischemia.Results In observation group,the levels of Lp-PLA2[asymptomatic myocardial ischemia(309.24±84.99)μg/L,symptomatic myocardial ischemia(264.56±74.52)μg/L],IMA[asymptomatic myocardial ischemia(104.21±33.90)kU/L,symptomatic myocardial ischemia(87.41±25.58)kU/L]were statistically significantly higher than those in control group[(158.63±32.84)μg/L,(68.05±15.99)kU/L](P<0.05).In patient with asymptomatic myocardial ischemia,the levels of Lp-PLA2 and IMA were statistically significantly higher than those in symptomatic myocardial ischemia patient(P<0.05).The change of heart rate in asymptomatic myocardial ischemia group was higher than that in symptomatic myocardial ischemia group,while ST-segment declined and ischemia duration were shorter than those in symptomatic myocardial ischemia group(P<0.05).The receiver operating characteristic(ROC)curve based on Lp-PLA2,IMA,and ECG was constructed for diagnosing asymptomatic myocardial ischemia,the area under ROC curve,sensitivity,specificity,and Youden index(0.959,98.1%,85.7%,0.857)of combined detection were all higher than single Lp-PLA2(0.802,88.9%,71.4%,0.603),IMA(0.751,64.8%,81.0%,0.458)and ECG(0.822,87.0%,76.2%,0.632).Conclusion It is demonstrated that Lp-PLA2 and IMA combined with ECG showed high sensitivity and specificity in diagnosis of asymptomatic myocardial ischemia,the level of Lp-PLA2 and IMA increased and ECG changed significantly in patient with asymptomatic myocardial ischemia.Therefore,the combined detection could effectively diagnose asymptomatic myocardial ischemia.