血清淀粉样蛋白A在缺血性及扩张型心肌病患者中的鉴别及临床意义

The Value of Serum Amyloid Ain Identification and Assessment between Ischemic Cardiomyopathy and Dilated Cadiomyopathy

目的:缺血性心肌病心力衰竭与扩张型心肌病心力衰竭均表现为充血性心力衰竭,在临床中不易鉴别。本文探讨血清淀粉样蛋白A(SAA)在二者鉴别中的临床价值。方法:选取60例住院患者,应用临床表现、心脏超声和部分患者冠脉造影检查作为金指标确定缺血性心肌病患者(A组,30例),扩张型心肌病患者(B组,30例),并选取健康对照组(C组,15例)。测定各组血清SAA浓度。比较各组SAA水平的差异,并绘制ROC曲线。结果:A组SAA水平明显高于C组,[(2.3805±1.267)ng/ml vs(0.9936±0.276)ng/ml,P<0.01],B组亦高于C组[(1.7567±0.2448)ng/ml vs(0.9936±0.276)ng/ml],P<0.01,但A组SAA水平明显高于B组,二者比较差异有统计学意义(P=0.0126)。ROC曲线显示,采用SAA浓度为1.929ng/ml作为界值诊断缺血性心肌病的灵敏度为60%,特异度为83.3%。所得阳性似然比为3.5928。结论:缺血性心肌病时SAA水平明显升高,而扩张型心肌病则不同,有鉴别诊断意义。

Objective：To discuss the clinical value of SAA in distinguishing ischemic cardiomyopathy and dilated cardiomyopathy both which present as congestive heart failure.Methods：We determined the levels of SAA in each patient when they are admitted and calculated the sensitivity,specificity,positive likelihood ration in patients with ischemic cardiomyopathy.We also describe the ROC curve,and compare the difference of SAA among the groups.Results：SAA were much higher in ICM and DCM patients than normal control [（2.3805±1.267,（1.7567±0.2448） vs.（0.9936±0.276））ng/ml,P〈0.01.But the level of SAA in ICM was also much higher than DCM（P=0.0126）.Using the concentration of SAA for 1.929 ng/ml as the boundary to diagnosis the ischemic cardiomyopathy,the sensitivity is 60%,and the specificity is 83.3%,and the positive likelihood ration are 3.5928.Conclusions：The level of SAA elevates obviously in ischemic cadiomyopathy.SAA could use as a clinical screening examination.