血清肌酸激酶同工酶水平对冠心病的诊断价值研究

Diagnostic Value of Serum CK-MB Level on Coronary Heart Disease

目的探讨血清肌酸激酶同工酶(CK-MB)水平对冠心病的诊断价值。方法连续选取2014年5—11月在江苏省人民医院行冠状动脉造影的疑似冠心病患者445例,根据血清CK-MB水平四分位数分为≤6.1 U/L者107例、6.2～8.4 U/L者112例、8.5～11.7 U/L者114例、≥11.8 U/L者112例。比较不同血清CK-MB水平患者临床资料(包括年龄、性别、吸烟情况、冠心病发生情况、收缩压、舒张压、实验室检查指标及Gensini积分);血清CK-MB水平与冠心病患者Gensini积分的相关性分析采用Spearman秩相关分析;绘制ROC曲线以评价血清CK-MB水平对冠心病的诊断价值;冠心病的影响因素分析采用单因素及多因素Logistic回归分析;采用分层分析评估血清CK-MB水平对不同性别、年龄患者冠心病发病风险的预测价值;采用叉生分析评价血清CK-MB水平与高血压、糖尿病在冠心病发病风险中的交互作用。结果 (1)不同血清CK-MB水平患者年龄、性别、冠心病发生率、舒张压、低密度脂蛋白(LDL)及Gensini积分比较,差异有统计学意义(P<0.05);不同血清CK-MB水平患者吸烟率、收缩压、高密度脂蛋白(HDL)、三酰甘油、肌酐及血糖比较,差异无统计学意义(P>0.05)。(2)Spearman秩相关分析结果显示,血清CK-MB水平与冠心病患者Gensini积分呈正相关(rs=0.17,P<0.01)。(3)ROC曲线显示,血清CK-MB水平诊断冠心病的曲线下面积(AUC)为0.66[95%CI(0.60,0.72)],最佳截断值为6.75 U/L,灵敏度为75%,特异度为51%。(4)单因素Logistic回归分析结果显示,血清CK-MB水平可能是冠心病的影响因素[OR=3.06,95%CI(1.89,4.94),P<0.01];进一步行多因素Logistic回归分析结果显示,血清CK-MB水平是冠心病的独立影响因素[OR=2.26,95%CI(1.32,3.86),P<0.01]。(5)分层分析结果显示,血清CK-MB水平>6.75 U/L预测女性患者冠心病的OR值高于男性患者(P<0.01);血清CK-MB水平>6.75 U/L预测年龄<60岁患者冠心病的OR值分别高于年龄为60～74岁、>74岁患者(P<0.01)。(6)叉生分析结果显示,血清CK-MB水平与高血压在冠心病发病风险中存在负交互作用[交互作用指数(SI)=0.92],交互作用超额相对危险度(RERI)为-0.57,交互作用归因比(AP)绝对值为0.08;血清CK-MB水平与糖尿病在冠心病发病风险中存在负交互作用(SI=0.68),RERI为-2.78,AP绝对值为0.41。结论血清CK-MB水平与冠状动脉狭窄程度有关,其对冠心病具有一定诊断价值,且血清CK-MB水平>6.75 U/L对女性、年龄<60岁、无高血压、无糖尿病者的冠心病发病风险预测价值较高。

A total of 445 suspected coronary heart disease patients were continuously selected in the People's Hospital of Jiangsu Province from May to November in 2014,and they were divided into A group(with serum CK-MB level equal or less than 6.1 U/L,n=107),B group(with serum CK-MB level from 6.2 to 8.4 U/L,n=112),C group(with serum CK-MB level from 8.5 to 11.7 U/L,n=114)and D group(with serum CK-MB level equal or over 11.8 U/L,n=112)according to the quartile of serum CK-MB level.Clinical data was compared in the four groups,including age,gender,smoking status,incidence of coronary heart disease,SBP,DBP,laboratory examination results and Gensini score;Spearman rank correlation analysis was used to analyze the correlation between serum CK-MB level and Gensini score in patients with coronary heart disease;ROC curve was drawn to evaluate the diagnostic value of serum CK-MB level on coronary heart disease;influencing factors of coronary heart disease were analyzed by univariate and multivariate Logistic regression analysis;predictive value of serum CK-MB level in predicting onset risk of coronary heart disease in patients with different gender or age was analyzed by stratification analysis;crossover analysis was used to evaluate the interaction between serum CK-MB level and hypertension,and diabetes on onset risk of coronary heart disease.Results (1)There were statistically significant differences of age,gender,incidence of coronary heart disease,DBP,LDL and Gensini score in the four groups(P<0.05),while no statistically significant differences of smoking rate,SBP,HDL,TG,Cr or FPG was found in the four groups(P>0.05).(2)Spearman rank correlation analysis results showed that,serum CK-MB level was positively correlated with Gensini score in patients with coronary heart disease(rs=0.17,P<0.01).(3)ROC curve showed that,the AUC of serum CK-MB level in diagnosing coronary heart disease was 0.66〔95%CI(0.60,0.72)〕,the optimum truncation value was 6.75 U/L,the sensitivity was 75%,the specificity was 51%.(4)Univariate Logistic regression analysis results showed that,serum CK-MB was one of possible influencing factors of coronary heart disease〔OR=3.06,95%CI(1.89,4.94),P<0.01〕;multivariate Logistic regression analysis results showed that,serum CK-MB level was one of independent influencing factors of coronary heart disease〔OR=2.26,95%CI(1.32,3.86),P<0.01〕.(5)Stratification analysis results showed that,OR of serum CK-MB level(over 6.75 U/L)in predicting coronary heart disease in female patients was statistically significantly higher than that in male patients(P<0.01);OR of serum CK-MB level(over 6.75 U/L)in predicting coronary heart disease in patients less than 60 years old was statistically significantly higher than that in patients from 60 to 74 years old,in patients over 74 years old,respectively(P<0.01).(6)Crossover analysis results showed that,there was significantly negative interaction between serum CK-MB level and hypertension on onset risk of coronary heart disease(SI=0.92,RERI=-0.57,absolute value of AP was 0.08);there was significantly negative interaction between serum CK-MB level and diabetes on onset risk of coronary heart disease(SI=0.68,RERI=-2.78,absolute value of AP was 0.41).Conclusion Serum CK-MB level was closely correlated with the degree of coronary artery stenosis,has certain diagnostic value on coronary heart disease;serum CK-MB level(over 6.75 U/L)has relatively high predictive value on onset risk of coronary heart disease in female patients,patients less than 60 years old,in patients without hypertension or diabetes.