基于ROC曲线分析HCY、hs-CRP、PCSK-9诊断原发性高血压患者颈动脉粥样硬化的价值

Value of HCY, hs-CRP and PCSK-9 in the diagnosis of carotid atherosclerosis in patients with essential hypertension based on ROC curve analysis

目的基于ROC曲线探究同型半胱氨酸(HCY)、超敏C-反应蛋白(hs-CRP)、前蛋白转化酶枯草溶菌素-9(PCSK-9)在原发性高血压患者颈动脉粥样硬化(AS)中的诊断价值。方法选择2016年10月至2017年5月上海市徐汇区精神卫生中心进行治疗的原发性高血压患者154例作为研究对象,根据颈动脉超声检测结果分为AS组(85例)与非AS组(69例),另选取同期在上海市徐汇区精神卫生中心进行体检的健康志愿者70例作为对照组,对总动脉以及颈内动脉内膜中厚度(IMT)进行测定,比较不同患者血清hs-CRP、HCY、PCSK-9水平,创建受试者工作特征曲线分析不同血清指标预测颈动脉粥样硬化的价值。结果 AS组、非AS组收缩压和舒张压均明显高于正常对照组,差异均有统计学意义(P<0.05)。AS组患者颈总动脉、颈内动脉左右两侧及平均IMT均高于非AS组差异均有统计学意义(P<0.05)。AS组hs-CRP、HCY、PCSK-9水平均高于非AS级、对照组,非AS组hs-CRP、HCY、PCSK-9水平均高于对照组差异均有统计学意义(P<0.05)。以颈动脉超声结果作为金标准,单项诊断中hs-CRP、HCY、PCSK-9诊断符合率分别为75.11%、66.96%、75.89%。hs-CRP联合HCY、PCSK-9联合HCY、PCSK-9联合hs-CRP以及三项联合检测诊断符合率分别为74.55%、71.42%、74.10%、87.50%。两项联合诊断灵敏度、特异度、符合率均高于单项诊断,误诊率、漏诊率低于单项诊断,三项联合诊断灵敏度、特异度、符合率高于两项联合诊断,误诊率、漏诊率低于两项联合诊断,差异均有统计学意义(P<0.05)。ROC曲线显示三项联合诊断AUC(0.886)值高于PCSK-9联合hs-CRP、hs-CRP联合HCY、PCSK-9联合HCY、HCY、hs-CRP、PCSK-9单项诊断(0.812、0.807、0.796、0.724、0.637、0.589)。结论 HCY、hs-CRP、PCSK-9对于发性高血压患者颈动脉粥样硬化诊断均有一定价值,三者联合检测后符合率、灵敏度、特异度得到明显提高,诊断价值更高。

Objective To explore the diagnostic value of homocysteine（HCY）, high sensitivity C-reactive protein（hs-CRP）, proprotein convertase subtilisin-9（PCSK-9） in primary hypertension with carotid atherosclerosis（AS）.Methods A total of 154 patients with primary hypertension, who admitted to Department of Clinical Laboratory of Xuhui District of Mental Health Center of Shanghai from October 2016 to May 2017, were selected and divided into the AS group（n=85） and non-AS group（n=69） according to the results of carotid ultrasound examination. Another 70 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the normal control group. The intima media thickness（IMT） of the common artery and internal carotid artery was measured,and the serum levels of hs-CRP, HCY, PCSK-9 were compared among different patients. The receiver operating characteristic curve was created to analyze the diagnostic value of different serum markers. Results The systolic blood pressure and diastolic blood pressure in the AS group and non-AS group were significantly higher than those in the normal control group（P0.05）. The average IMT of the carotid artery and the left and right sides of the internal carotid artery in the AS group were significantly higher than those in the non-AS group（P0.05）. The hs-CRP, HCY and PCSK-9 in AS group were higher than those in the non-AS group and the control group, and the hs-CRP, HCY and PCSK-9 levels in the non-AS group were significantly higher than those in the control group（P0.05）. Taking the carotid ultrasound results as the gold standard, the diagnostic accuracy rates of hs-CRP, HCY and PCSK-9 in single diagnosis were 75.11%,66.96%, 75.89%, respectively, and the diagnostic coincidence rates of hs-CRP combined with HCY, PCSK-9, HCY, PCSK-9 combined with hs-CRP, and the combination of three indexes were 74.55%, 71.42%, 74.10%, 87.50%, respectively. The diagnostic sensitivity, specificity and coincidence rate of the combination of two indexes were significantly higher than those of single diagnosis test, and the rates of misdiagnosis and missed diagnosis were significantly lower than those of single diagnosis test; the diagnostic sensitivity, specificity and coincidence rate of the combination of the three indexest were significantly higher than those of the combination of the two indexes, and the rates of misdiagnosis and missed diagnosis were significantly lower than those of the combination of the two indexes（P0.05）. The ROC curve showed that the diagnostic AUC values of the combination of three indexes were 0.886, which were significantly higher than 0.812, 0.807, 0.796, 0.724, 0.637, 0.589 of PCSK-9 combined with hs-CRP, hs-CRP combined with HCY, PCSK-9 combined with HCY, HCY, hs-CRP, and PCSK-9. Conclusion HCY, hs-CRP and PCSK-9 are valuable in the diagnosis of carotid atherosclerosis in patients with hypertension, and the combination of the three indexes can improve the coincidence rate, sensitivity and specificity, with higher diagnostic value.