血清胱抑素C水平对冠心病的诊断价值

Diagnostic Value of Serum Cys-C Level on Coronary Heart Disease

目的分析血清胱抑素C(Cys-C)水平对冠心病的诊断价值。方法选取铜陵市人民医院2012年6月—2015年6月收治的因疑似冠心病入院治疗患者416例,根据冠状动脉造影结果将患者分为冠心病组252例和非冠心病组164例。冠心病患者中稳定型心绞痛(SAP)88例(SAP组)、非ST段抬高急性冠脉综合征(NST-ACS)126例(NST-ACS组)、ST段抬高型心肌梗死(STEMI)38例(STEMI组)。记录冠心病组和非冠心病组患者的一般资料,分别在入院时和入院7 d后采用乳胶免疫比浊法检测血清Cys-C水平,并绘制ROC曲线评价入院时血清Cys-C水平对SAP的诊断价值。结果冠心病组与非冠心病组患者年龄、体质指数、吸烟史阳性率、血脂异常史阳性率、冠心病病史阳性率及估算肾小球滤过滤(e GFR)比较,差异无统计学意义(P>0.05);冠心病组患者男性所占比例、糖尿病及高血压病史阳性率均高于非冠心病组(P<0.05)。入院时SAP组患者血清Cys-C水平高于非冠心病组、NST-ACS组和STEMI组,入院7 d后SAP组、NST-ACS组和STEMI组患者血清Cys-C水平高于非冠心病组(P<0.05)。多因素logistic回归分析结果显示,治疗7 d后血清Cys-C水平是冠心病的独立危险因素〔OR=3.725,95%CI(1.248,11.119),P<0.05〕。绘制入院时血清Cys-C水平诊断SAP的ROC曲线,结果显示,当血清Cys-C为1.015 mg/L时,其诊断SAP的特异度和灵敏度最高,分别为72.0%和80.2%,曲线下面积为0.805〔95%CI(0.674,0.937)〕。结论 ACS患者急性期血清Cys-C水平无明显变化,SAP患者入院时血清Cys-C水平即已升高,且血清Cys-C水平对SAP具有一定的诊断价值。

Objective To analyze the diagnostic value of serum Cys-C level on coronary heart disease. Methods A total of 416 suspected coronary heart disease patients were selected in the People’ s Hospital of Tongling from June 2012 to June2015,and they were divided into control group（ did not diagnosed as coronary heart disease, n = 164） and case group（ diagnosed as coronary heart disease,n = 252） according to coronary angiography examination results,thereinto 88 patients diagnosed as stable angina pectoris were served as A group,126 patients diagnosed as non ST- segment elevation acute coronary syndrome were served as B group,38 patients diagnosed as ST- segment elevation myocardial infarction were served as C group. General information of control group and case group were recorded after admission,serum Cys-C level was detected by latex immune turbidimetry at admission and 7 days after admission,respectively,ROC curve was drew to evaluate the diagnostic value of serum Cys-C level（ at admission） on stable angina pectoris. Results No statistically significant differences of age,BMI,positive rate of smoking history, of dyslipidemia, positive rate of coronary heart disease history or e GFR was found between control group and case group（ P 〉 0. 05）,while the proportion of male,positive rates of diabetes and hypertension of case group were statistically significantly higher than those of control group（ P 〈 0. 05）. Serum Cys-C level at admission of A group was statistically significantly higher than that of control group,B group and C group,respectively; serum Cys-C level after 7 days of admission of A group,of B group,of C group was statistically significantly higher than that of control group,respectively（ P 〈0. 05）. Multivariate logistic regression analysis showed that,serum Cys-C level after 7 days of admission was an independent risk factor of coronary heare disease 〔OR = 3. 725,95% CI（ 1. 248,11. 119）,P 〈 0. 05 〕. ROC curve showed that,the AUC of serum Cys-C level（ at admission） was 0. 805 〔95% CI（ 0. 674,0. 937） 〕 in the diagnosis of stable angina pectoris,when it was 1. 015 mg / L,the sensitivity was 80. 2%,the specificity was 72. 0%. Conclusion Serum Cys-C level of patients with acute coronary syndrome does not significantly changed, while serum Cys-C level of patients with stable angina pectoris is significantly elevated at admission,it has certain diagnostic value in the diagnosis of stable angina pectoris.