肌红蛋白和胱抑素C联合改良HEART评分法对急诊胸痛早期危险分层的临床价值分析

The clinical value of Mb and Cys C combined with modified HEART score in emergency chest pain

目的:探讨肌红蛋白(Mb)、胱抑素C(CysC)联合改良HEART评分法在鉴别诊断急诊心源性胸痛危险分层的临床价值。方法:选择369例我院接诊的急诊胸痛患者,其中271例为心源性胸痛(心源性胸痛组),98例为非心源性胸痛(非心源性胸痛组)。均进行血清Mb、CysC检测和改良HEART评分、传统HEART评分评估,分析Mb、CysC联合改良HEART评分对心源性胸痛鉴别价值。结果:心源性胸痛组血清Mb、CysC水平、改良HEART评分、传统HEART评分均高于非心源性胸痛组(P<0.05),Logistic回归分析Mb、CysC、改良HEART评分与心源性胸痛的发生密切相关(P<0.01)。受试者工作特征曲线(ROC)分析结果示Mb、CysC、改良HEART评分、Mb+CysC+改良HEART评分鉴别心源性胸痛的曲线下面积(AUC)分别为0.783、0.737、0.872、0.933。结论:联合Mb、CysC和改良HEART评分可提高对急诊胸痛病因鉴别的准确率,指导急诊胸痛危险分层。

Objective:To investigate the clinical value of myoglobin(Mb), cystatin C(Cys C) combined with modified HEART score in the differential diagnosis of acute cardiogenic chest pain risk stratification. Method: Three hundred and sixty-nine patients with acute chest pain in our hospital were selected, among which 271 were cardiac chest pain(cardiac chest pain group) and 98 were non-cardiac chest pain(non-cardiac chest pain group). Mb and Cys C tests, improved HEART score and traditional HEART score were performed on all patients, and the value of Mb and Cys C combined improved HEART score in the identification of cardiogenic chest pain was analyzed. Result: The levels of serum Mb, Cys C, modified HEART score and traditional HEART score in the cardiogenic chest pain group were all higher than those in the non-cardiogenic chest pain group(P<0.05). Logistic regression analysis showed that Mb, Cys C and improved HEART score were correlated with the occurrence of cardiogenic chest pain(P<0.01). The Receiver operator characteristics curve(ROC) analysis results showed that the area under the curve(AUC) of Mb, Cys C, modified HEART score and Mb+Cys C+ modified HEART score for the identification of cardiogenic chest pain were 0.783, 0.737, 0.872, 0.933, respectively. Conclusion: The combination of Mb, Cys C and modified HEART score can improve the accuracy of identifying the etiology of chest pain in emergency, and guide the risk stratification of chest pain in emergency.