2项指标联合检测在心肌损伤评价中的价值

Evaluation value of combined determinations of two markers for heart damage

目的评价心肌损伤标志物N末端B型利钠肽原(NT-proBNP)、心肌肌钙蛋白I(cTnI)、肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)及天门冬氨酸氨基转移酶(AST)联合检测对急性心肌梗死的诊断价值。方法收集156例急性心肌梗死者和106例非急性心肌梗死者的血清,NT-ProBNP、cTnI、Mb采用酶免法检测,CK-MB使用免疫抑制法检测,AST采用速率法检测。对几种标志物可能的各种组合建立Logistic回归模型,以预测概率为分析指标,应用受试者工作特征(ROC)曲线分析,评价不同组合对急性心肌梗死的诊断价值。结果单一指标评价,NT-ProBNP灵敏度(83.3%)与特异度(98.5%)最高,以基于Logistic回归的ROC曲线分析各项组合,敏感度和特异度均有所提高。双指标组合中,NT-ProBNP/cTnI组合的ROC曲线下面积最高为0.995,诊断效能最高,敏感度、特异度分别为91.2%、99.5%。结论基于Logistic回归的ROC曲线分析方法可以为多指标联合诊断试验提供更客观的综合分析,NT-ProBNP、cTnI、Mb、CK-MB、AST联合检测具有互补作用,NT-ProBNP与cTnI联合检测能使诊断敏感度和特异度进一步提高。

Objective To investigate the diagnostic value of combined detection of cardiac markers for heart failure,including A- mino-terminal pro-B-type natriuretric peptide （NT-ProBNP）, serum troponin I （ cTnI）, Mbglobin （ Mb）, creatine kinase isoenzyme （CK-MB）and alanine transaminase（AST）. Methods Serum samples were derived from ]$6 acute heart failure patients and 106 pa- tients as negative controls. NT-ProBNP, eTnI, Mb were tested by immunoassay, and CK-MB were tested by immunoinhibition, AST were tested by rate method. The different Logistic regression models were established for various combined determinations of cardi- ac markers. The predicted probability was used as the analyzed variable. Receiver Operating Characteristic（ROC） curve was applied to evaluate the diagnostic accuracy of different combined determinations. Results The sensitivity and the specificity（98. 5 %） of NT-ProBNP were the highest single detection. The results which were analyzed by ROC curve based on Logistic regression showed that the sensitivity and specificity of two-marker combinations were improved. In two-marker combinations, NT-ProBNP/cTnI whose area under ROC curve （AUC） was 0.995, had the highest diagnostic accuracy, and its sensitivity, specificity were91.2 %, 99. 5% respectively. Conclusion The approach of ROC curve based on Logistic regression could improve synthetic efficiency for com- bined determination of multiple markers. The combined detection of NT-ProBNP, cTnI, Mb, CK-MB, AST have a complementary effect for evaluating acute heart failure, combined detection of NT-ProBNP and cTnI would improve the detection effect remark- ably.