血清LP-PLA2、cTnⅠ及LOX-1对老年急性冠脉综合征患者早期诊断的价值分析

Analysis value of serum in early diagnosis of elderly patients with acute coronary syndrome

目的:探讨血清脂蛋白相关磷脂酶A2(LP-PLA2)、肌钙蛋白Ⅰ(cTnⅠ)和凝集素样氧化低密度脂蛋白受体-1(LOX-1)对老年急性冠脉综合征患者早期诊断的价值。方法:选择2015年2月~2019年4月至我院住院治疗确诊为急性冠脉综合征(ACS)的老年患者220例作为研究对象,选取同期的正常对照组70例。220例ACS患者中包括稳定型心绞痛(SAP)患者80例、不稳定型心绞痛(UAP)75例和急性心肌梗死(AMI)65例。采用酶联免疫法检测各组血清中LP-PLA2、cTnⅠ及LOX-1的表达水平,同时应用ROC曲线评价LP-PLA2、cTnⅠ和LOX-1等指标在ACS的早期诊断价值。结果:ACS各组患者的LP-PLA2、cTnⅠ和LOX-1的表达水平均高于对照组(P<0.05);其中AMI和UAP组患者的LP-PLA2、cTnⅠ和LOX-1的表达水平均高于SAP组(P<0.05);AMI患者的LP-PLA2、cTnⅠ和LOX-1高于UAP组,差异具有统计学意义(P<0.05)。经Spearman相关性分析,ACS患者中LP-PLA2与cTnⅠ和LOX-1的水平呈正相关(r=0.875,P<0.05;r=0.701,P<0.05)LOX-1与cTnⅠ水平呈正相关(r=0.759,P<0.05)。ROC曲线分析显示,LP-PLA2、cTnⅠ和LOX-1的ROC曲线下面积(AUC)分别是0.871、0.962和0.989,LP-PLA2的诊断敏感度和特异度分别为82.7%和75.0%,cTnⅠ的诊断敏感度和特异度分别为92.5%和82.8%,LOX-1的诊断敏感度和特异度分别为82.8%和95.0%。结论:LP-PLA2、cTnⅠ和LOX-1在ACS患者组水平显著高于对照组,显示LP-PLA2、cTnⅠ和LOX-1可作为检测老年ACS的检测指标,且具有较高的特异度和敏感度,具有重要的预测、诊断和治疗指导价值。

Objective:To investigate the value of serum lipoprotein-associated phospholipase A2(LP-PLA2),troponinⅠ(cTnⅠ)and lectin-like oxidized low density lipoprotein receptor-1(LOX-1)in the early diagnosis of elderly patients with acute coronary syndrome.Methods:A total of 220 elderly patients who were diagnosed with acute coronary syndrome(ACS)were enrolled in our hospital from February 2015 to April 2019.At the same time,70 patients in the normal control group were selected.Among the 220 patients with ACS,80 patients with stable angina pectoris(SAP),75 patients with unstable angina pectoris(UAP)and 65 patients with acute myocardial infarction(AMI).The expression levels of LP-PLA2,cTnⅠand LOX-1 in serum were detected by enzyme-linked immunosorbent assay.At the same time,ROC curve was used to evaluate the early diagnostic values of LP-PLA2,cTnⅠand LOX-1 in ACS.Results:The expression levels of LP-PLA2,cTnⅠand LOX-1 in ACS patients were higher than those in the control group(P<0.05).The expression levels of LP-PLA2,cTnⅠand LOX-1 were higher in patients with AMI and UAP than those in SAP group(P<0.05);LP-PLA2,cTnⅠand LOX-1 in patients with AMI were higher than those in UAP group,the difference was statistically significant(P<0.05).According to Spearman correlation analysis,LP-PLA2 was positively correlated with cTnⅠand LOX-1 levels in ACS patients(r=0.875,P<0.05;r=0.701,P<0.05).LOX-1 was positively correlated with cTnⅠlevel(r=0.759,P<0.05).ROC curve analysis showed that the area under the ROC curve(AUC)of LP-PLA2,cTnⅠand LOX-1 were 0.871,0.962 and 0.989,respectively,and the diagnostic sensitivity and specificity of LP-PLA2 were 82.7%and 75.0%,respectively.The diagnostic sensitivity and specificity of cTnⅠwere 92.5%and 82.8%,respectively,and the diagnostic sensitivity and specificity of LOX-1 were 82.8%and 95.0%,respectively.Conclusion:The levels of LP-PLA2,cTnⅠand LOX-1 in the ACS group are significantly higher than those in the control group,indicating that LP-PLA2,cTnⅠand LOX-1 can be used as indicators for detecting ACS in the elderly,and have high specificity and sensitivity,with important predictive,diagnostic and therapeutic guidance value.