两种血清标志物联合24 h动态心电图对老年冠心病并发无症状心肌缺血的诊断价值

Value of two serum markers combined with 24 h dynamic ECG in diagnosis of CHD with asymptomatic myocardial ischemia in the elderly

目的研究缺血修饰蛋白(IMA)、髓过氧化物酶(MPO)联合24 h动态心电图(DEG)检测对老年冠心病并发无症状心肌缺血的诊断价值。方法选取我院2018年1月~2019年6月收治的150例疑似老年冠心病无症状心肌缺血患者作为研究对象,均行24 h DEG检查,同时检测患者血清IMA、MPO水平,以冠状动脉造影(CAG)结果为诊断金标准,根据检测结果分为CAG阳性组(96例)、CAG阴性组(54例)。比较2组患者血清IMA、MPO水平,并评估IMA、MPO、24 h DEG单项或联合检测在诊断中的效能。结果 CAG显示阴性患者为36.0%,阳性患者为64.0%。CAG阳性组患者血清IMA、MPO水平及心肌缺血发作持续时间显著高于CAG阴性组,有显著差异(P<0.05,P<0.01)。CAG阴性组ST段压低980阵次,CAG阳性组ST段压低249阵次,心肌缺血发作时间主要集中在06?01~12?00。ROC曲线分析显示,IMA、MPO的截断值分别为135.39×10^3 U/L、589.25 ng/L,曲线下面积分别为0.760(95%CI:0.712~0.806)、0.757(95%CI:0.684~0.793),两者联合诊断的曲线下面积为0.926(95%CI:0.858~0.987)。IMA、MPO、24 h DEG三者联合检测特异性、准确率高于单项检测(98.15%vs 59.26%、70.37%、74.07%,均P=0.000;91.33%vs 82.00%、84.00%、80.00%,P=0.017、0.037、0.005)。结论IMA、MPO联合24 h DEG检测可有效提高老年冠心病并发无症状心肌缺血临床诊断的特异性及准确率,同时保持了较高的敏感性,对于患者的早期筛查和诊断具有重要的临床应用价值。

Objective To study the value of two serum markers(IMA and MPO) combined with 24 h dynamic ECG in diagnosis of CHD with asymptomatic myocardial ischemia(AMI) in the elderly.Methods One hundred and fifty suspected CHD patients with AMI admitted to our hospital from January 2018 to June 2019 who underwent 24 h dynamic ECG and measurement of serum IMA and MPO levels were divided into CAG-positive group(n=96) and CAG-negative group(n=54).Their serum levels of IMA and MPO were measured and compared.The value of IMA,MPO and 24 h dynamic ECG alone or their combination in diagnosis of CHD with AMI was assessed.Results CAG showed that CAG-negative patients and CAG-positive patients accounted for 36% and 64% respectively.The serum levels of IMA and MPO were significantly higher and the course of AMI was significantly longer in CAG-positive group than in CAG-negative group(P<0.05,P<0.01).The attacking time of AMI was mainly from 06?01 to 12?00,during which the ST segment decreased 980 times in CAG-negative group and 249 times in CAG-positive group.ROC curve analysis showed that the cut-off value was 135.39×10^3 U/L and 589.25 ng/L respectively,the AUC for IMA and MPO in diagnosis of CHD with AMI in the elderly was 0.760 and 0.757 respectively(95%CI:0.712-0.806,95%CI:0.684-0.793),and the AUC for IMA and MPO combined with 24 h dynamic ECG was 0.926(95%CI:0.858-0.987).The specificity and accuracy of IMA,MPO combined with 24 h dynamic ECG were significantly higher than those of IMA,MPO or 24 h dynamic ECG alone(98.15% vs 59.26%,70.37%,74.07%,P=0.000,P=0.000,P=0.000;91.33% vs 82.00%,84.00%,80.00%,P=0.017,P=0.037,P=0.005).Conclusion IMA and MPO combined with 24 h dynamic ECG can effectively improve the specificity,accuracy and sensitivity in diagnosis of CHD with AMI and are of great value for early screening and diagnosis of CHD with AMI in the elderly.