颈动脉内膜中层厚度与同型半胱氨酸和D-二聚体水平早期诊断急性冠状动脉综合征的临床意义

Early Diagnosis Value of Carotid IMT, Hcy and D-D Levels in Patients with Acute Coronary Syndrome

目的 探讨测定颈动脉内膜中层厚度（IMT）与同型半胱氨酸（Hcy）和D-二聚体（D-D）水平早期诊断急性冠状动脉综合征（ACS）的临床意义.方法 采用彩色多普勒超声测定178例ACS患者（稳定斑块72例和不稳定斑块106例）和83例稳定性心绞痛（SAP）患者的IMT,同时测定血清Hcy和D-D水平,并进行对比性研究.受试者工作特征（ROC）曲线评估稳定斑块向不稳定斑块转化时血清Hcy和D-D的水平.结果 ACS患者与SAP患者的性别、年龄、体质量指数（BMI）和糖尿病情况差异无统计学意义（P均〉0.05）.ACS患者血清Hcy和D-D水平较之SAP患者显著增高（P均〈0.01）.不稳定斑块患者血清Hcy和D-D水平较之稳定斑块患者明显增高（P〈0.05,P〈0.01）.ROC曲线显示：血清Hcy和D-D的曲线下面积（AUC）分别为0.873和0.894,cut-off值分别为7.88μmol/L和0.56μg/mL,敏感性分别为92.58%和95.36%,特异性分别为86.60%和89.42%.结论 测定IMT水平可以鉴别ACS患者的严重程度,血清Hcy和D-D水平是评估稳定斑块转化为不稳定斑块的有价值指标.

Objective To explore the early diagnosis value of carotid IMT, Hcy and D-D levels in patients with acute coronary syndrome （ACS）. Methods The IMT level was determined in 178 patients with ACS and 83 patients with SAP by color Doppler ultrasonography. ACS patients were divided into stable plaque group （n=72） and unstable plaque group （n=106）. And their Hcy and D-D levels were analyzed and compared. ROC curve was used to calculate the cut off value of Hcy and D-D levels from stable plaque to unstable plaque. Results There was no significant difference in the sex, age, BMI and diabetic between ACS patients and SAP patients （P all 〉0.05）. The Hcy and D-D levels were significantly higher in ACS patients than those of SAP patients （P all〈0.01）. The Hcy and D-D levels were significantly higher in unstable plaque group than those of stable plaque group （P〈0.05, P〈0.01）. The ROC curve showed： AUC of Hcy and D-D was 0.873 and 0.894, respectively; cut-off value was 7.88μmol/L and 0.56 μg/mL, respectively; sensitivity was 92.58% and 95.36%, respectively; specificity was 86.60%and 89.42%, respectively. Conclusion The severity of ACS can be identified by determining IMT level. The serum Hcy and D-D levels were valuable for predicting stable plaque translate to unstable plaque.