急性冠脉综合征患者IMA与hs-CRP、cTnT诊断价值

Diagnostic value of IMA hs-CRP and cTnT to patients with ACS

目的探讨缺血修饰蛋白(IMA)、超敏CRP(hs-CRP)以及肌钙蛋白T(cTnT)与急性冠脉综合征(ACS)的诊断价值。方法选择50例临床确诊为ACS的患者,测定其血清IMA、hs-CRP、cTnT的水平,并与40例健康体检者进行对照分析,计算单项或联检的敏感性和特异性,绘制ROC曲线,计算ROC曲线下面积。结果 50例ACS患者IMA与hs-CRP、cTnT水平明显高于健康对照组(P值均<0.001)。IMA与hs-CRP、cTnT水平呈负相关(r=-0.53、-0.50,P<0.01)。ACS患者IMA与hs-CRP、cTnT的ROC曲线下面积(AUCROC)分别为0.936、0.657、0.856,在最适诊断参考值分别为70.15 U/mL、1.30 mg/L、0.01μg/L,诊断的灵敏度为87.5%、78.0%、80.0%,特异度分别为96.0%、57.5%、80.0%,约登指数分别为0.84、0.36、0.60,阳性似然比分别为21.88、1.84、4.00,阳性预测值分别为90%、70%、83%,阴性预测值分别为94%、68%、76%,三项联合检测灵敏度可达99.5%。结论血清中IMA和hs-CRP、cTnT水平升高与心肌缺血程度有密切关系。IMA可作为急性心肌缺血的早期诊断指标,对ACS具有较高诊断价值,三项联合检测可明显提高了ACS早期诊断的灵敏度。

Objective To discuss the diagnostic value of IMA hs-CRP and cTnT to patients with ACS.Methods We chose 50 cases patients who were clinical diagnosis with ACS to determine the IMA,hs-CRP,cTnT contents in their serum samples,and analyzed them with 40 healthy persons,calculated sensitivity and specificity of the single and combined detection,drew ROC cures,then calculated the area AUCROC.Results The levels of IMA,hs-CRP,cTnT of 50 cases patients with ACS were obviously higher than 40 health persons（P0.001）.It showed negative correlation between IMA and hs-CRP,cTnT（r=-0.53,-0.50,P0.01）.The AUCROC which the IMA,hs-CRP,cTnT of patients with ACS were 0.936,0.657,0.856,the optimal reference was 70.15U/mL,1.30mg/L,0.01μg/L,the sensitivity was 87.5%,78.0%,80.0%,the specificity each was 96.0%,57.5%,80.0%,the Yourdon＇s index each was 0.84,0.36,0.60,the positive likelihood ratio was 21.88,1.84,4.00,the positive predictive values were 90%,70%,83%,the negative predictive values were 94%,68%,76%,the sensitivity of combined detection was 99.5%.Conclusions There are closely relationship between the elevation of IMA and hs-CRP,cTnT in the serum and degrees of myocardial ischemia.IMA can be considered as early diagnostic index for acute myocardial ischemia,which has high diagnostic value.Combined detection obviously can improve the sensitivity of early diagnostic for ACS.