通过ROC曲线评估联合检测TnI、hs-CRP和NT-proBNP对老年急性冠状动脉综合征的诊断价值

Diagnostic value of combined measurement of TnI,hs-CRP and NT-proBNP by ROC curve in elderly patients with acute coronary syndrome

目的:通过ROC曲线探讨肌钙蛋白I(TnI)、超敏C反应蛋白(hs-CRP)和N末端脑利钠肽前体(NT-proBNP)联合检测在老年急性冠状动脉(冠脉)综合征(ACS)临床诊断中的应用价值。方法:收集不稳定型心绞痛(UA组,60例)、非ST段抬高型心肌梗死(NSTEMI组,61例)、ST段抬高性心肌梗死(STEMI组,59例)患者及健康者(对照组,60例)血清样本,用化学发光免疫法检测TnI,电化学发光免疫法检测NT-proBNP,速率散射免疫比浊法测定hs-CRP;绘制ROC曲线并建立Logistic回归模型,分析各指标单独和联合检测在UA、NSTEMI及STEMI诊断中的作用。结果:除UA组TnI外,ACS 3个组中血清TnI、hs-CRP与NT-proBNP值显著高于对照组(P<0.05);与单独检测相比,3项指标联合检测时,UA组、NSTEMI组和STEMI组ROC曲线下面积(AUC)[(0.858±0.051)、(0.988±0.013)和(0.998±0.004)]最大,灵敏度(57.8%、95.9%和99.1%)和特异度(94.7%、100.0%和100.0%)也最好。结论:联合检测TnI、hs-CRP和NT-proBNP有助于老年ACS中UA的诊断,对NSTEMI与STEMI的灵敏度和特异度也能达到最优化,但对区分NSTEMI和STEMI效果不明显。

Objective：To evaluate the value of combined measurement of TnI,hs-CRP and NT-proBNP in the clinical diagnosis of acute coronary syndrome（ACS） for elderly patients by ROC curve. Method：Collected adequate serum samples from unstable angina（UA） group（n=60）,non-ST elevations myocardial infarction（NSTEMI） group（n=61）,ST elevations myocardial infarction（STEMI） group（n=59） and healthy control group（n=60）.TnI was detected by chemiluminescent immunoassay,NT-proBNP by electrochemistry luminescentce immunoassay,and hs-CRP by rate scattering immunoturbidimetric assay.Then analysis the value of combined measurement of TnI,hs-CRP and NT-proBNP in UA,NSTEMI,and STEMI diagnosis by ROC curve and Logistic regression model. Result：Except for TnI in UA group,the serum levels of TnI,hs-CRP and NT-proBNP in 3 ACS groups were significantly higher than those in healthy control group（both P〈0.05）.Compared to test alone,combined measurement had bigger area under the ROC curve（AUC） in UA,NSTEMI and STEMI group [（0.858±0.051）,（0.988±0.013）,（0.998±0.004）],as well as better sensitivity and specificity（57.8%,94.7%;95.9%,100.0%;99.1%,100.0%）. Conclusion：Combined measurement of TnI,hs-CRP and NT-proBNP can significantly improve the diagnosis of UA for elderly patients,and achieve the best sensitivity and specificity for NSTEMI and STEMI,but the effect of distinguishing between NSTEMI and STEMI is little.