缺血修饰白蛋白和氨基末端脑钠肽前体联合动态心电图在无症状心肌缺血诊断中的价值

The value of the combined detection of IMA, NT-proBNP and dynamic electrocardiogram in the diagnosis of silent myocardial ischemia

目的:评价缺血修饰白蛋白(IMA)和氨基末端脑钠肽前体(NT-proBNP)联合动态心电图(DEG)检查对无症状心肌缺血的临床诊断价值。方法:对114例疑诊冠心病无症状心肌缺血患者进行IMA、NT-proBNP和DEG检测,并与冠状动脉造影(CAG)检查结果对比分析。结果:114例疑诊患者中,CAG阳性68例,占59.65%;IMA测定60例为阳性患者,与CAG结果比较其特异度为82.61%,灵敏度为88.24%;NT-proBNP测定63例为阳性患者,与CAG结果比较其特异度为80.43%,灵敏度为92.64%;DEG检查57例为阳性患者,与CAG结果比较其特异度为86.96%,灵敏度为83.82%;3项联合测定66例为阳性患者,与CAG结果比较其特异度为95.65%,灵敏度为97.06%。联合检查特异度和灵敏度明显提高,与单独IMA、NT-proBNP和DEG结果比较其差异均有统计学意义(F=140.637,F=255.467;P<0.05)。结论:将IMA、NT-proBNP和DEG联合检查结果进行综合分析,既可提高诊断的特异性,也可提高诊断的敏感性,可做为无症状心肌缺血早期诊断的重要筛查手段。

Objective：To evaluate the clinical value of combined detection of ischemia modified albumin（IMA）, N-terminal pro brain natriuretic peptide（NT-proBNP） and dynamic electrocardiogram（DEG） in the diagnosis of silent myocardial ischemia.Methods： IMA, NT-proBNP and DEG of 114 patients with silent myocardial ischemia who were suspected coronary heart disease were detected, and then these results were compared and analyzed with the results of coronary angiography（CAG）.Results： In 114 patients with suspected coronary heart disease, 68 cases（59.65%）were positive as the results of CAG. And there were 60 cases were positive as the results of IMA detection, and the specificity and sensitivity of IMA compared with CAG were 82.61% and 88.24%, respectively. There were 63 cases were positive as the results of NT-proBNP, and the specificity and sensitivity of NT-proBNP compared with CAG were 80.43% and 92.64%, respectively. There were 57 cases were positive as the results of DEG, and the specificity and sensitivity of DEG compared with CAG were 86.96% and 83.82%, respectively. While there were 66 cases were positive as the combined detection of the three methods, and specificity and sensitivity of the combined detection compared with CAG were 95.65% and 97.06%, respectively. Therefore, the specificity and sensitivity of combined detection were significantly higher than that of alone detection of IMA, NT-proBNP and DEG （F=140.637,F=255.467,P〈0.05）.Conclusion： The comprehensive analysis for the combined detections of IMA, NT-proBNP and DEG can increase both of the specificity and sensitivity of diagnosis, and it can be used as a important screening method for earlier finding silent myocardial.