ACS患者炎性因子和心肌标志物水平及相关性分析

Levels of inflammatory factors and myocardial markers in ACS patients and their correlation analysis

目的:研究急性冠脉综合征(ACS)患者血清cTnI、hsCRP、CK-MB和NT-proBNP水平间的相关性和诊断价值。方法:我院收治的231例ACS患者被分为UAP组(128例)、NSTEMI组(64例)和STEMI组(39例),选择同期健康志愿者60例作为健康对照组。比较各组血清cTnI、hsCRP、CK-MB和NT-proBNP水平,分析其相关性,以及对ACS的诊断价值。结果:与健康对照组比较,UAP组、NSTEMI组和STEMI组血清hsCRP[(0.91±0.61)mg/L比(21.49±3.81)mg/L比(43.70±5.49)mg/L比(60.61±7.35)mg/L]、CK-MB[(3.26±0.39)μg/L比(40.14±1.62)μg/L比(46.74±2.37)μg/L比(59.57±6.72)μg/L]、cTnI[(0.28±0.12)μg/L比(4.77±0.33)μg/L比(5.19±0.43)μg/L比(5.36±0.46)μg/L]和NT-proBNP[(57.61±7.91)pg/ml比(542.64±52.86)pg/ml比(1064.93±111.63)pg/ml比(1495.44±149.64)pg/ml]水平均显著升高,P均=0.001;血清hsCRP、CK-MB和NT-proBNP水平均符合UAP组<NSTEMI组<STEMI组,两两比较均有显著差异,P均=0.001。Pearson相关性分析显示,血清NT-proBNP水平与hsCRP、CK-MB水平呈显著正相关(r=0.520,0.439,P=0.031,0.001)。hsCRP、CK-MB、cTnI、NT-proBNP水平的曲线下面积(AUC)分别为0.799、0.811、0.763、0.832,截断值分别为2.01mg/L、5.03μg/L、0.80μg/L、80.03pg/ml,约登指数分别为0.593、0.638、0.518、0.668,且均具有较好的特异性和敏感性。结论:ACS患者血清CK-MB、cTnI、hsCRP、NT-proBNP水平显著升高,以上4指标水平有助于ACS患者的辅助诊断。

Objective:To study serum levels of cTnI,hsCRP,CK-MB and NT-proBNP,correlation among them and their diagnostic value in patients with acute coronary syndrome(ACS).Methods:A total of 231 ACS patients treated in our hospital were divided into UAP group(n=128),NSTEMI group(n=64)and STEMI group(n=39),another 60 healthy volunteers were simultaneously enrolled as healthy control group.Serum levels of cTnI,hsCRP,CK-MB and NT-proBNP were compared among above groups,their correlations and diagnostic value for ACS were analyzed.Results:Compared with healthy control group,there were significant rise in serum levels of hsCRP[(0.91±0.61)mg/L vs.(21.49±3.81)mg/L vs.(43.70±5.49)mg/L vs.(60.61±7.35)mg/L],CK-MB[(3.26±0.39)μg/L vs.(40.14±1.62)μg/L vs.(46.74±2.37)μg/L vs.(59.57±6.72)μg/L],cTnI[(0.28±0.12)μg/L vs.(4.77±0.33)μg/L vs.(5.19±0.43)μg/L vs.(5.36±0.46)μg/L]and NT-proBNP[(57.61±7.91)pg/ml vs.(542.64±52.86)pg/ml vs.(1064.93±111.63)pg/ml vs.(1495.44±149.64)pg/ml]in UAP group,NSTEMI group and STEMI group,P=0.001 all;serum levels of hsCRP,CK-MB and NT-proBNP were accorded with UAP group<NSTEMI group<STEMI group,there existed significant difference between any two groups,P=0.001 all.Pearson correlation analysis indicated that serum NT-proBNP level was significant positively correlated with hsCRP and CK-MB levels(r=0.520,0.439,P=0.031,0.001).AUC of hsCRP,CK-MB,cTnI and NT-proBNP was 0.799,0.811,0.763 and 0.832 respectively,cutoff value of them was 2.01mg/L,5.03μg/L,0.80μg/L and 80.03pg/ml respectively,and Yoden′s index of them was 0.593,0.638,0.518 and 0.668 respectively,and all possessed good specificity and sensitivity.Conclusion:Serum levels of CK-MB,cTnI,hsCRP and NT-proBNP significantly rise in ACS patients.Above four indexes are helpful to auxiliary diagnosis of ACS.