应用ROC曲线评价α-羟丁酸脱氢酶对不稳定型心绞痛急性发作的诊断价值

EVALUATION ON α-HBDH AS A DIAGNOSTIC MARKER FOR ACUTE ONSET OF UNSTABLE ANGINA PECTORIS BY ROC ANALYSIS

目的采用受试者操作特性(receiver operatmg characteristic,ROC)曲线评价α-羟丁酸脱氢酶(α-hydroxybutyratedehydrogenase,α-HBDH)对不稳定型心绞痛(unstable angina,UA)急性发作的诊断价值。方法应用连续监测法检测83例UA患者的心肌酶谱,记录其中的α-HBDH数值,根据发作后1～2、12及24 h患者α-HBDH水平与正常对照组α-HBDH水平描绘ROC曲线并进行分析。结果UA发作后1～2、12及24 h ROC曲线下面积分别为0.449、0.453和0.538,3组间比较差异无统计学意义。以240 U/L为临界值,UA急性发作后1～2 h血清α-HBDH诊断UA急性发作的敏感性51%、特异性58%、阳性预测值0.53、阴性预测值0.56、准确度48%;12h的敏感性54%、特异性58%、阳性预测值0.54、阴性预测值0.58、准确度56%;24 h的敏感性60%、特异性58%、阳性预测值0.57、阴性预测值0.61、准确度59%。结论α HBDH对UA急性发作的诊断性能指标均较低,并无其不可替代的诊断价值,可以将之从心肌酶中去除,常规生化检测应淘汰α-HBDH。

Objective To evaluate α-hydroxybutyrate dehydrogenase （α-HBDH） as a diagnostic marker for acute onset of unstable angina pectoris（UA） by using receiver operating characteristic（ROC） analysis. Methods α-HBDH levels in serial serum samples from 83 UA patients in different periods were detected by continuous monitor assay. The results of α-HBDH level during the period of 1-2,12 and 24 h after onset and those of controllers were compared. ROC curve was analyzed according to the α-HBDH levels of different periods. Results If 240 U/L was used as cutoff value,the area under curve（AUC） of different periods was 0. 449,0. 453 and 0. 538 respectively,there were no significant difference among three groups. The sensitivity of the period of 1-2 h for diagnosis of angina pectoris onset was 51% ,the specificity was 58% ,positive predictive value was 0.53, negative predictive value was 0.56, and the accuracy was 48%. The sensitivity of the period of 12 h was 54% ,the specificity was 58% ,positive predictive value was 0.54, negative predictive value was 0.58, and the accuracy was 56%. The sensitivity of the period of 24 h was 60% ,the specificity was 58% ,positive predictive value was 0. 57 , negative predictive value was 0.61,and the accuracy was 59%. Conclusion α-HBDH can not be regard as a special serum marker of unstable angina pectoris,and its diagnostic value can be neglected. In order to avoid excessive laboratory examination, it can be deleted in routine biochemical examination.