急性冠脉综合征早期诊断中不同血清标记物组合的比较

A Comparison of Different Combination of Biochemical Markers in Early Diagnosis of Acute Coronary Syndrome

目的通过对不同血清标记物组合早期诊断急性冠脉综合征的价值进行比较,探讨妊娠相关血浆蛋白-A(PAPP-A)在提高组合诊断效能方面的作用。方法检测急性冠脉综合征患者、急性冠脉综合征疑似患者PAPP-A、超敏C反应蛋白(hs-CRP)和肌钙蛋白I(cTnI)水平,绘制3种标记物用于诊断急性冠脉综合征的受试者特征曲线(ROC曲线),冉根据ROC曲线确定三者诊断急性冠脉综合征的诊断阈值,并对确立的标记物组合"PAPP-A+cTnI"、"cTnI+hs-CRP"和"PAPP-A+cTnI+hs-CRP"的诊断准确度进行比较。结果三种标记物诊断急性冠脉综合征的ROC曲线下面积分别为:PAPP-A 0.978(95%CI 0.956～1.000),cTnI 0.873(95%CI 0.797～0.948),hs-CRP0.841(95%CI 0.761～0.920):依此确定的三种标记物用于诊断急性冠脉综合征的诊断阈值为:PAPP-A 17.225μg/mL,hs-CRP 6.215mg/L,cTnI 1.030ng/mL。PAPP-A、hs-CRP、cTnI、"PAPP-A+cTnI"、"cTnI+hs-CRP"和"PAPP-A+cTnI+hs-CRP"的敏感度依次为0.889、0.733、0.689、0.956、0.956和0.956;特异度为0.956、0.778、1.000、0.956、0.778和0.756:诊断正确率为0.922、0.778、0.833、0.956、0.878和0.856。"PAPP-A+cTnI"较之于单独的标记物及其它组合,具有较高的诊断正确率(0.956)、较高的诊断特异度(0.956)、诊断敏感度(0.956)和阳性预测值(0.956)。结论组合"PAPP-A+cTnI"对急性冠脉综合征的综合诊断价值较高,对于急性冠脉综合征的早期诊断具有更高的诊断价值。

Objective To compare the different combination of biochemical markers in early diagnosis of acute coronary syndrome （ACS）. Methods Serum PAPP-A, hs-CRP and cTnI concentrations were measured in 45 ACS patients and 45 suspected patients.ROC curves of three markers established respectively, and the cut off values were determined accordingly. Diagnostic accuracy of the markers was calculated and compared. The diagnostic accuracy （Se, Sp, diagnostic accuracy rate） of the three combinations（＂PAPP-A ＋cTnI＂, ＂hs-CRP＋cTnI＂ and ＂PAPP-A＋hs-CRP＋ cTnI＂） and the three markers themselves were calculated and compared. Results Compared with the suspected patients,the AUCs of the three markers were： PAPP-A 0.978 （95%CI 0.956 to 1.000）, hs-CRP 0.841 （95%CI 0.761 to 0.920）, cTnI 0.873 （95%CI 0.797 to 0.948）. Respectively cut off values of the three markers for diagnosing ACS were defined as PAPP-A17.225 μg/mL, hs-CRP 6.215 mg/L and cTnI 1.030 ng/mL. The diagnostic accuracy of these markers and their combinations （PAPP-A, hs-CRP, cTnI, ＂PAPP-A＋cTnI＂, ＂cTnI＋hs-CRP＂ and ＂PAPP-A＋ cTnI＋hs-CRP＂ ） were calculated and presented as follows ： sensitivity ： 0.889,0.733,0.689,0.956,0.956,0.956; specificity ： 0.956,0.778,1.000,0.956,0.778,0.756 ; diagnostic efficacy ： 0.922,0.778,0.833,0.956,0.878,0.856.Compared with the other markers and combinations, the combination of ＂PAPP-A ＋ cTnI＂ had higher sensitivity, specificity and diagnostic accurancy. Conclusions The combination of ＂PAPP-A ＋ cTnI＂ can improve the sensitivity and specificity of the early diagnosing ACS.