8项检验指标对冠心病中医证型鉴别诊断的价值

The values of 8 clinical laboratory indicators in the differential diagnosis of TCM syndrome types for patients with coronary heart disease

目的评估脑利钠肽前体(proBNP)、D-二聚体(D-D)、纤维蛋白原(Fib)、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)、低密度脂蛋白胆固醇(LDL-C)、血小板计数(PLT)、心肌肌钙蛋白T(cTnT)8项检验指标对冠心病中医证型的鉴别诊断价值。方法本研究纳入了2017年1-9月于中国中医科学院西苑医院诊断为冠心病的患者427例,将患者按中医辨证分为6种中医证型,检测各证型患者上述8项检验指标,采用受试者工作特征曲线(ROC曲线)分析以上各指标对中医证型的鉴别诊断价值。结果 proBNP、D-D、Fib、Hcy、hsCRP、PLT、cTnT的单个指标检测对冠心病血瘀证的鉴别诊断均有一定价值,其中proBNP对痰阻血瘀证与气虚血瘀痰阻证的鉴别诊断灵敏度为94.9%,对气虚血瘀证与痰阻血瘀证的鉴别诊断特异度为95.2%,proBNP对冠心病气滞血瘀证与气虚血瘀痰阻证鉴别诊断的ROC曲线下面积为0.820。部分指标的联合检测可提高其诊断价值,其中D-D与proBNP联合检测鉴别诊断痰瘀互结证与气阴两虚证的灵敏度为87.0%,cTnT与PLT联合检测鉴别诊断痰瘀互结证与气虚血瘀痰阻证的特异度为87.9%,proBNP与D-D联合检测对冠心病气滞血瘀证与气阴两虚证鉴别诊断的ROC曲线下面积为0.790。结论 proBNP、D-D、Fib、Hcy、hs-CRP、PLT、cTnT对冠心病不同中医证型之间的鉴别诊断具有一定价值,尤其是D-D、proBNP联合检测用于鉴别冠心病气滞血瘀证和气阴两虚证的诊断价值较高。

Objective To explore the correlation between TCM syndrome types of coronary heart disease and eight clinical laboratory indicators including proBNP,D-D,Fib,Hcy,hs-CRP,LDL-C,PLT,cTnT in patients with coronary heart disease.Methods Totally427patients diagnosed as coronary heart disease in Xiyuan Hospital of Chinese Academy of Traditional Chinese Medicine from January to September2017were enrolled in the study.427patients with coronary heart disease were divided into six TCM syndrome types.The eight indicators were tested for the patients,and then the receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of the indicators for different syndrome types.Results When proBNP,D-D,Fib,Hcy,hs-CRP,PLT,cTnT were used as single indicators,they all had certain differential diagnostic values for TCM syndromes of coronary heart disease.The sensitivity of proBNP in the differential diagnosis of phlegm blocking and blood stasis syndrome from phlegm obstruction due to qi deficiency and blood stasis syndrome was94.9%.The differential diagnosis specificity of proBNP to syndrome of blood stasis due to qi deficiency and syndrome of phlegm blocking and blood stasis was95.2%.The area under curve(AUC)was0.820when proBNP was used as a single indicato in the differential diagnosis of syndrome of qi stagnation and blood stasis from syndrome of phlegm obstruction due to qi deficiency and blood stasis.The combined detection of some indicators could improve the diagnostic value.The sensitivity of D-D combined with proBNP in differential diagnosis of syndrome of intermin-gled phlegm and blood stasis and syndrome of deficiency of both qi and yin was87.0%.The specificity of combined detection of cTnT and PLT in the differential diagnosis of syndrome of intermin-gled phlegm and blood stasis and syndrome of phlegm obstruction due to qi deficiency and blood stasis was87.9%.The differential diagnosis area under the ROC of combined detection of proBNP and D-D of syndrome of qi stagnation and blood stasis and syndrome of deficiency of both qi and yin was0.790.Conclusion proBNP,D-D,Fib,Hcy,hs-CRP,PLT,cTnT have certain value in differential diagnosis between different syndrome types of coronary heart disease.In particular,the combined detection of D-D and proBNP is of high value in the diagnosis of syndrome of qi stagnation and blood stasis and syndrome of deficiency of both qi and yin in coronary heart disease.