红细胞膜总胆固醇含量对急性冠状动脉综合征的诊断价值

The value of total cholesterol content of erythrocyte membrane in diagnosis of acute coronary syndrome

目的探讨急诊胸痛患者红细胞膜总胆固醇含量（CEM）对急性冠状动脉综合征（ACS）的诊断价值。方法选择80例急诊胸痛疑似ACS患者,其中男55例,女25例;年龄（53.6±7.2）岁。胸痛发作3h内和3~6h分别留取血样测定CEM、CK-MB、cTnI的含量,结合冠状动脉造影和冠状动脉内超声结果,参照AHA/ACC标准将患者分为3组：ACS组、稳定型心绞痛（SAP）组、非冠心病（NCHD）组,分别比较3 h内和3~6 h各组CEM、CK-MB、cTnI的差异,并观察CEM、CK-MB、cTnI联合检测对ACS的诊断价值。对ACS组患者随访,比较心血管事件亚组和无心血管事件亚组CEM含量的差异。结果 80例入选对象中,诊断为ACS 30例,SAP 26例,NCHD 24例。ACS组CEM水平在3h内和3~6 h均明显高于SAP组和NCHD组（P均〈0.05）。3 h内CK-MB、cTnI水平在各组间差异无统计学意义（P〉0.05）;3~6 h,ACS组CK-MB、cTnI水平高于SAP组和NCHD组（P〈0.05）。SAP组和NCHD组在3 h、3~6h各指标差异均无统计学意义（P〉0.05）。联合检测CEM、CK-MB、cTnI诊断ACS的敏感性、特异性、阳性预测值及阴性预测值分别为98.5%、95.6%、98.%和99.3%,均明显高于CK-MB、cTnI联合检测（89.8%、87.5%、90.3%、91.5%）,差异有统计学意义（P〈0.05）。心血管事件亚组（12例）的CEM含量明显高于无心血管事件亚组（18例）,差异有统计学意义（P〈0.01）。结论检测CEM含量可以在心肌坏死标志物升高之前预测ACS的发生,能弥补CK-MB、cTnI对ACS诊断的局限性,与CK-MB、cTnI联合检测能进一步提高对ACS的诊断价值。

Objective To evaluate the diagnostic value of total cholesterol content of erythrocyte membrane（CEM）for acute coronary syndrome（ACS）.Methods 80 patients with chest pain in emergency department who were suspected of ACS were enrolled,including 55 males and 25 females;aged（53.6±7.2）years within 3 h of onset of chest pain and 3~6h blood specimens were measured CEM,CK-MB,cTnI levels,combined coronary angiography and intracoronary ultrasound findings,referring to AHA/ACC criteria were divided into three groups：ACS group,stable angina pectoris（SAP）group and non-coronary heart disease（NCHD）groups.They were compared within 3 h and 3~6h each group CEM,CK-MB,cTnl differences and observe CEM,CK-MB,cTnI combined detection of the ACS diagnostic value.Follow-up of patients with ACS compared cardiovascular events with and without cardiovascular events＇ CEM content differences.Results 80 cases of selected objects,diagnosis of ACS were 30 cases,SAP were 26 cases,NCHD 24 cases.ACS group CEM levels within 3 h and 3~6h were significantly higher than SAP and NCHD group（P0.05）.Within 3 h CK-MB,cTnl levels in all groups showed no significant difference（P0.05）;3~6h,ACS group CK-MB,cTnl levels higher than SAP and NCHD group（P0.05）.SAP and NCHD group at 3 h,3~6 h each index showed no significant difference（P0.05）.Combined detection of CEM,CK-MB,cTnI diagnosis of ACS sensitivity,specificity,positive predictive value and negative predictive value were98.5%,95.6%,98.7%,and 99.3%.significantly higher than CK-MB,cTnl joint detection（89.8%,87.5%,90.3%,91.5%）,the difference was statistically significant（P0.05）.CEM of cardiovascular events subgroup（12 cases）were significantly higher than the without cardiovascular events subgroup（18 cases）.the difference was statistically significant（P0.01）.Conclusion CEM content can be detected at elevated markers of myocardial necrosis predicted before the occurrence of ACS,can make up for CK-MB,cTnI limitations of the ACS diagnosis,and CK-MB,cTnl joint detection can further improve the diagnostic value of the ACS.