和肽素在非ST段抬高急性冠脉综合征诊断中的应用研究

Analysis on the Application of the Copeptin in the Diagnosis of Non-ST Segment Elevation Acute Coronary Syndrome

目的探讨和肽素(Copeptin)在非ST段抬高急性冠脉综合征诊断中的应用研究。方法收集在上海市浦东医院心内科收治发病4 h内的非ST段抬高急性冠脉综合征患者120例(观察组),随机选取40例冠脉造影无异常患者为对照组。检测患者发病后4 h、12 h和24 h的血浆Copeptin及超敏肌钙蛋白I(cTnI),并与对照组比较。通过ROC曲线评估Copeptin的最佳诊断点,计算敏感性及特异性。结果在发病后4 h、12 h和24 h中,患者血浆Copeptin和cTnI水平明显高于对照组,差异有统计学意义(P<0.05)。对NSTE-ACS组不同时间段血浆Copeptin和cTnI水平进行组内比较,差异有统计学意义(F分别=5.87、12.36,P均<0.05)。通过ROC曲线,Copeptin的最大曲线下面积(AUC)为0.739,最佳诊断点为11.03 pmol/L,此时诊断NSTE-ACS的敏感性为90.0%,特异性为67.5%。而cTnI以0.05 ng/ml为诊断临界点,诊断NSTE-ACS的敏感性为51.9%,特异性为95.0%。结论和肽素对非ST段抬高急性冠脉综合征的诊断敏感性优于超敏肌钙蛋白I,具有较好的诊断价值,值得临床应用。

OBJECTIVE To observe the application of the Copeptin in the diagnosis of non-ST segment elevation acute coronary syndrome.METHODS 120 patients with suspected non-ST segment elevation acute coronary syndrome within 4 hours of onset（named the Observer Group） were collected in hospital Cardiology,then randomly selected 40 healthy patients as a control group.The serum copeptin and sensitive troponin I were detected respectively after onset 4h,12 h,24h,and compared with the control group.Assessment the best diagnostic point of the Copeptin by the ROC curve,and calculate the sensitivity and specificity.RESULT After onset4 h,12h,24 h,the serum copeptin and sensitive troponin I significantly higher than the control group,the difference was statistically significant（P〈0.05）.The plasma Copeptin and cTnI levels were compared within the NSTE-ACS group for different time periods,the difference was statistically significant（F respectively=5.87,12.36,P〈0.05）.Through ROC curve,the largest area under the curve（AUC） of Copeptin was 0.739,and the best diagnostic point of 11.03pmol/L,at this point,the diagnostic sensitivity of NSTE-ACS was90.0%and specificity of 67.5%.cTnI was 0.05 ng/ml as the diagnosis of the critical point,the diagnostic sensitivity of NSTE-ACS was 51.9%,specificity of 95.0%.CONCLUSION The diagnostic sensitivity of Copeptin in non-ST segment elevation acute coronary syndrome was superior to sensitive troponin I,with a good diagnostic value,which was worthy of clinical application.