心肌和炎性标志物联合检测在老年急性冠状动脉综合征患者诊断中的应用

Joint detection of troponin T, high sensitivity C-reactive protein, N-terminal probrain natriuretic peptide applied in the diagnosis of acute coronary syndrome for elderly patients

目的探讨肌钙蛋白T（TnT）、N末端利钠肽前体（NT—proBNP）和超敏C反应蛋白（hs—CRP）3项心肌和炎性标志物联合检测在老年人急性冠状动脉综合征（ACS）诊断中的应用价值。方法收集不稳定型心绞痛（UA）组（49例）、非ST段抬高的心肌梗死（NSTEMI）组（48例）、其他急性心肌梗死（AMI）组（37例）及健康对照组（45例）血清样本，用电化学发光双抗体夹心法检测TnT、NT—proBNP，免疫透射比浊法测定hs—CRP；通过绘制受试者工作特征（ROC）曲线和建立Logistic回归模型，分析各指标单独和联合检测在UA、NSTEMI及其他AMI诊断中的价值。结果ACS3组中患者血清TnT（除外UA组）、NT-proBNP和hs—CRP水平高于健康对照组（均P〈0．05）。TnT、NT—proBNP和hs—CRP单独与联合检测ACS各分组中ROC曲线下面积（AUC）最大，分别为UA组：0．583±0．059、0．786±0．047、0．620±0．058和0．787±0．046；NSTEMI组：0．967±0．022、0．978±0．015、0．897±0．032和0．991±0．009；其他AMI组：0．971±0．024、0．961±0．021、0．874±0．043和0．999±0．002，TnT、NT—proBNP和hs—CRP联合检测与单独检测相比，ROC曲线下面积均有不同程度的提高。TnT、NT—proBNP和hs—CRP单独与联合检测的敏感度和特异性分别为UA组：16．7％、100．0％、54．2％、91．1％、54．2％、75．6％和50．0％、95．6％；NSTEMI组：93．5％、100．0％、95．7％、97．8％、67．4％、97．8％及95．7％和100．O％；其他AMI组：94．1％、100．0％、91.2％、97．8％、67．8％、97．8％及100．0％、97．8％。结论联合检测TnT、NT—proBNP、hs～CRP能改善老年ACS中UA的诊断效果，对于NSTEMI和其他AMI也能使敏感度和特异性达到最优化，但对区分NSTEMI和其他AMI效果不明显。

Objective To investigate the value of the joint detection of Troponin T（TnT）, high- sensitivity C-reactive protein （hs-CRP） and N-terminal probrain natriuretie peptide （NT-proBNP） for the clinical diagnosis of acute coronary syndrome（ACS） in elderly patients. Methods The adequate serum samples were collected in each group： unstable angina （UA） （49 cases）, non-ST segment elevations myocardial infarction（NSTEMI） （48 cases）, acute myocardial infarction（AMI） （37 cases） and healthy control （45 cases）. The levels of TnT and NT-proBNP were measured by electrochemiluminescent double antibody sandwich method, and hs-CRP by immune transmission turbidity. The roles of individual and joint detection of the three indicators were analyzed by ROC curve and Logistic regression model. Results Except for TnT in UA group, the serum TnT, NT-proBNP and hs-CRP levels were significantly higher in three ACS groups than in healthy control group （P〈0.05）. The largest areas under the ROC curve （AUC） of individual TnT, NT-proBNP, hs CRP testing and the joint detection for UA were 0. 583±0. 059, 0. 786±0. 047, 0. 620±0. 058 and 0. 787 ±0. 046, for NSTEMI were 0. 967±0. 022, 0. 978±0. 015, 0. 897±0. 032 and 0. 991±0. 009, for AMI were 0. 971 ± 0. 024, 0. 961 ± 0. 021, 0. 874 ± 0. 043 and 0. 999 ± 0. 002, therefore, the area under the ROC curve of the joint detection was increased to some degree as compared with individual TnT, NT-proBNP, hs-CRP testing. Similarly, the best sensitivity and specificity of individual TnT, NT proBNP, hs-CRP testing and the joint detection for UA were 16.7% and 100.0%, 54.2% and 91.1% , 54.2% and 75.6%, 50% and 95.6%; for NSTEMIwere93.5% and 100.0%, 95.7% and 97.8%, 67.4% and 97.8%, 95.7% and 100.0% for AMI were 94.1% and 100.0%, 91.2% and 97.8%, 67.8% and 97.8%, 100.0% and 97.8%, respectively. Conclusions Joint detection of TnT, NT-proBNP, hs-CRP can significantly improve the diagnosis of UA; for NSTEMI and other AMI, it can be achieved the optimism of sensitivity and specificity, but its effect of distinguishing NSTEMI and AMI is little.