Hcy、hs-CRP及LDLC联合检测对冠心病的诊断价值

Value of combined detection of Hcy,hs-CRP and LDLC in the diagnosis of coronary heart disease

目的研究同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)及低密度脂蛋白胆固醇(LDLC)联合检测对冠心病(CHD)的诊断价值。方法回顾性分析90例CHD患者临床资料,根据病情将其分为稳定型心绞痛(SAP)组42例、不稳定型心绞痛(UAP)组29例及急性心肌梗死(AMI)组19例;将同期30例行冠状动脉造影检查排除CHD的非心脑血管疾病患者纳入对照组。应用受试者工作曲线(ROC曲线)评价Hcy、hs-CRP、LDLC及三者联合对CHD的诊断价值。结果Hcy、hs-CRP、LDLC ROC曲线显示AUC分别为0.832、0.895、0.747(P均<0.05),灵敏度分别为0.667、0.867、0.767,特异度分别为0.900、0.800、0.667。3者联合预测AUC为0.971,灵敏度、特异度分别为0.878、1.000,优于各自单独预测(P<0.05)。肌酸激酶同工酶(CKMB)、肌钙蛋白T(cTnT)、肌钙蛋白Ⅰ(cTnⅠ)诊断CHD的灵敏度分别为0.889、0.867、0.878,特异度分别为0.667、0.633、0.600,与上述Hcy、hs-CRP、LDLC诊断价值相近;3种心肌酶谱联合诊断CHD的灵敏度、特异度分别为0.889、0.833略低于Hcy、hs-CRP、LDLC联合诊断价值。结论血清Hcy、hs-CRP、LDLC水平与CHD发生、发展密切相关,联合检测对CHD诊断有一定价值。

Aim To study the diagnostic value of combined detection of homocysteine(Hcy),high-sensitivity C-reactive protein(hs-CRP)and low-density lipoprotein cholesterol(LDLC)on coronary heart disease(CHD).Methods The clinical data of 90 patients with CHD were retrospectively analyzed.According to the disease condition,they were divided into stable angina pectoris(SAP)group(n=42),unstable angina pectoris(UAP)group(n=29)and acute myocardial infarction(AMI)group(n=19).Another 30 patients with non-cardiovascular and cerebrovascular diseases who underwent coronary angiography and excluded CHD during the same period were included in control group.Receiver operating characteristic curve(ROC curve)was used to evaluate the diagnostic value of Hcy,hs-CRP,LDLC and combination of the three on CHD.Results ROC curves of Hcy,hs-CRPand LDLC showed that the AUC values were 0.832,0.895 and 0.747 respectively(P<0.05),and the sensitivities were 0.667,0.867 and 0.767,and the specificities were 0.900,0.800 and 0.667.The AUC,sensitivity and specificity of combined prediction of the three were 0.971,0.878 and 1.000 respectively,which were better than the individual prediction(P<0.05).The sensitivities of creatine kinase isoenzymes(CKMB),cardiac troponin T(cTnT)and cardiac troponin I(cTn I)in the diagnosis of CHD were 0.889,0.867 and 0.878 respectively,and the specificities were 0.667,0.633 and 0.600 respectively,which were similar to the diagnostic value of above-mentioned Hcy,hs-CRPand LDLC.The sensitivity and specificity of the three myocardial enzymes in the diagnosis of CHD were 0.889 and 0.833 respectively,which were slightly lower than those of combined diagnosis of Hcy,hs-CRP and LDLC.Conclusions The levels of serum Hcy,hs-CRP and LDLC are closely related to the occurrence and development of CHD.Combined detection has certain value in the diagnosis of CHD.