HEART评分联合D-二聚体对急性心肌梗死早期诊断的价值

Value of HEART score combined with D-dimer for early diagnosis of acute myocardial infarction

目的探讨HEART评分联合D-二聚体对急性心肌梗死的早期诊断价值。方法选取中国科学技术大学附属第一医院2017年1月至2018年12月间收治的280例急诊胸痛患者为研究对象,分为心源性胸痛组172例(急性心肌梗死亚组100例和心绞痛亚组72例)、非心源性胸痛组108例。收集所有患者的病史、年龄、危险因素、肌钙蛋白I及D-二聚体浓度及心电图检查结果。分别使用传统HEART和改良HEART法评分并比较。结果心源性胸痛组患者的改良HEART评分和传统HEART评分均高于非心源性胸痛组,差异有统计学意义(P<0.05)。心源性胸痛组患者的改良HEART评分高于传统HEART评分,差异有统计学意义(P<0.05)。急性心肌梗死亚组的改良HEART评分、传统HEART评分均高于心绞痛亚组,差异有统计学意义(P<0.05)。急性心肌梗死亚组中0~3 h段的改良HEART评分与传统HEART评分比较,差异无统计学意义(P>0.05);3~12 h段的改良HEART评分高于传统HEART评分,差异有统计学意义(P<0.05)。低危组改良HEART评分与传统HEART评分预测急性心肌梗死准确性比较,差异无统计学意义(P>0.05);高危组改良HEART评分预测急性心肌梗死准确性比传统HEART评分高,差异有统计学意义(P<0.05)。改良HEART评分预测急性心肌梗死的曲线下面积、灵敏度、特异度均高于传统HEART评分,差异有统计学意义(P<0.05)。结论HEART评分联合D-二聚体的改良HEART评分系统预测急性心肌梗死的准确性提高,对早期诊断急性心肌梗死很有价值,值得在临床推广。

Objectives To evaluate the value of HEART score combined with D-dimer in early diagnosis of acute myocardial infarction.Methods A total of 280 emergency chest pain patients admitted to The First Affiliated Hospital of University of Science and Technology of China from January 2017 to December 2018 were selected.They were divided into cardiogenic chest pain group(n=172,including 100 cases of acute myocardial infarction subgroup and 72 cases of angina pectoris subgroup)and noncardiogenic chest pain group(n=108).The medical history,age,risk factors,concentrations of troponin I and D-dimer,results of electrocardiography of all the patients were monitored and recorded.Results Both modified HEART score and traditional HEART score of cardiogenic chest pain group were significantly higher than those of non-cardiogenic chest pain group(P<0.05).Modified HEART score was significantly higher than traditional HEART score in cardiogenic chest pain group(P<0.05).Modified HEART score and traditional HEART score of acute myocardial infarction subgroup were significantly higher than those of angina subgroup(P<0.05).In acute myocardial infarction subgroup,there was no significant difference between modified HEART score and traditional HEART score in segment 0-3 h(P>0.05),and modified HEART score was significantly higher than traditional HEART score in segment 3-12 h(P<0.05).Compared with traditional HEART score,there was no significant difference in accuracy of prediction of acute myocardial infarction in low-risk group(P>0.05),while accuracy of prediction of acute myocardial infarction in high-risk group was improved(P<0.05).Area under the curve,sensitivity and specificity of modified HEART score in predicting acute myocardial infarction were higher than that of traditional HEART score,and the difference was statistically significant(P<0.05).Conclusions Modified HEART score system combined with Ddimer improves the accuracy of predicting acute myocardial infarction.It has value in early diagnosis of acute myocardi⁃al infarction and is worthy of clinical promotion.