应用ROC曲线评价不同方法检测同型半胱氨酸对高血压合并脑梗死的诊断价值

Evaluation on diagnostic value of Hcy detected by different assays in hypertension complicating cerebral infarction by ROC curve

目的探讨不同方法检测同型半胱氨酸(homocysteine,Hcy)对高血压合并脑梗死的诊断价值。方法分别采用荧光定量法和循环酶法检测单纯高血压组、高血压合并脑梗死组及健康对照组Hcy的水平,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析评价2种方法检测Hcy对高血压合并脑梗死的诊断效能。结果两种方法均显示单纯高血压组、高血压合并脑梗死组血清Hcy水平、高Hcy发生率均显著高于对照组(P<0.05),但单纯高血压组与高血压合并脑梗死组之间血清Hcy水平及高Hcy发生率均无明显差异(P>0.05)。ROC曲线分析循环酶法检测Hcy的诊断灵敏度(67.5%)和特异性(85.3%)均较高,而荧光定量法灵敏度较低(40%),特异性好(97.1%);Hcy与三酰甘油联合诊断的灵敏度为72.5%,特异性为94.1%,均高于Hcy单指标诊断效能。结论 Hcy的升高与高血压相关,但与高血压合并脑梗死并非有直接的因果关系。循环酶法检测Hcy对高血压合并脑梗死的诊断效能优于荧光定量法,Hcy与三酰甘油联合检测有助于提高对高血压合并脑梗死诊断灵敏度和特异性。

Objective To evaluate the value of homocysteine（Hcy）detection by different assays in the diagnosis of hypertension complicating cerebral infarction disease.Methods Serum concentration of Hcy in the patients with single hypertension,hypertension complicating cerebral infarction and healthy controls were detected by the fluorescence quantification assay and the enzymatic cycling assay respectively,the application value of the two assays in the diagnosis of hypertension complicating cerebral infarction disease was evaluated by the receiver operating characteristic（ROC）curve.Results Both the two assays showed that the serum Hcy level and incidence of high Hcy in the single hypertension group and the hypertension complicating cerebral infarction group were obviously higher than those in the healthy control group（P〈0.05）,but there were no statistically significant differences between the single hypertension group and the hypertension complicating cerebral infarction group（P〉0.05）.The ROC curve analysis showed that the sensitivity and the specificity in the enzymatic cycling assay were higher,which were 67.5%and 85.3%respectively,but the fluorescence quantification assay had lower sensitivity（40.0%）and higher specificity（97.1%）.Compared to the single index test,the sensitivity of Hcy and triglyceride combination detection had higher sensitivity（72.5%）and higher specificity（94.1%）,which were higher than the diagnostic performance of the single index.Conclusion The increase of serum Hcy level is closely related to hypertension,but is not a direct causal relationship with hypertension complicating cerebral infarction.The enzymatic cycling assay is better than the fluorescence quantitative assay in the diagnostic performance of hypertension complicating cerebral infarction.The combination detection of Hcy and triglyceride conduces to improve the diagnostic sensitivity and specificity.