血清Ang-2、cTnI和NT-proBNP联合检测在急性冠状动脉综合征诊断及预后评估中的价值

The value of combined detection of serum Ang-2,cTnI and NT-proBNP in the diagnosis and prognosis evaluation of acute coronary syndrome

目的探讨血清血管生成素-2(Ang-2)、心肌肌钙蛋白Ⅰ(cTnI)、N末端B型利钠肽原(NT-proBNP)联合检测在急性冠脉综合征(ACS)诊断及预后评估中的价值。方法选取2019年在徐州医科大学连云港东方医院心内科住院的70例ACS患者作为研究对象,其中ST段抬高型心肌梗死(STEMI)组32例,非ST段抬高型心肌梗死(NSTEMI)组20例,不稳定型心绞痛(UAP)组18例;另选取同期健康体检者60例作为对照组。采用酶联免疫吸附试验检测血清Ang-2水平,采用电化学发光法检测血清NT-proBNP、cTnI水平,采用受试者工作特征曲线(ROC曲线)分析血清Ang-2、cTnI和NT-proBNP对ACS的诊断效能,并对ACS患者进行为期12个月的随访,记录主要不良心血管事件(MACE)发生情况。结果STEMI组、NSTEMI组和UAP组血清Ang-2、cTnI和NT-proBNP水平均明显高于对照组,差异均有统计学意义(P<0.05);单项指标检测诊断ACS时Ang-2诊断效能最佳,其ROC曲线下面积(AUC)为0.887(95%CI:0.843~0.931),灵敏度、特异度分别为88.32%、80.24%;Ang-2、cTnI和NT-proBNP联合检测诊断ACS的AUC为0.928(95%CI:0.892~0.965);ACS患者有13例发生MACE,发生MACE患者血清Ang-2、cTnI和NT-proBNP水平均明显高于未发生MACE患者,差异均有统计学意义(P<0.05);ROC曲线分析结果显示,Ang-2、cTnI和NT-proBNP联合检测预测ACS预后效能最高,AUC为0.934(95%CI:0.900~0.968);多因素Logistic回归分析结果显示,Ang-2和NT-proBNP水平升高是ACS患者12个月内发生MACE的独立危险因素。结论Ang-2、cTnI和NT-proBNP联合检测可提高ACS的诊断和预后评估效能,Ang-2和NT-proBNP是ACS患者12个月内发生MACE的独立危险因子。

Objective To explore the value of combined detection of serum angiopoietin-2(Ang-2),cardiac troponin I(cTnI)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)in the diagnosis and prognostic evaluation of acute coronary syndrome(ACS).Methods Selected 70 cases of ACS patients hospitalized in the Department of Cardiology,Lianyungang Oriental Hospital Affiliated to Xuzhou Medical University in 2019 as research subjects,including 32 cases in ST segment elevation myocardial infarction(STEMI)group,20 cases in non-ST segment elevation myocardial infarction(NSTEMI)group,and 18 cases in the unstable angina pectoris(UAP)group.Another 60 cases of healthy people underwent physical examination in the same period were selected as the control group.The level of serum Ang-2 was detected by enzyme-linked immunosorbent assay,and the levels of serum NT-proBNP and cTnI were detected by electro chemiluminescence,the receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic efficacy of serum Ang-2,cTnI and NT-proBNP for ACS.ACS patients were followed up for 12 months,and the occurrence of major adverse cardiovascular events(MACE)was recorded.Results The serum Ang-2,cTnI and NT-proBNP levels in the STEMI group,NSTEMI group and UAP group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).Ang-2 had the best diagnostic performance when a single index detection was used to diagnose ACS,its area under the ROC curve(AUC)was 0.887(95%CI:0.843-0.931),sensitivity and specificity were 88.32%and 80.24%respectively.The AUC of Ang-2,cTnI and NT-proBNP combined detection in the diagnosis of ACS was 0.928(95%CI:0.892-0.965).A total of 13 cases ACS patients developed MACE,and serum Ang-2,cTnI and NT-proBNP levels in MACE patients were significantly higher than those in patients without MACE,the differences were statistically significant(P<0.05).The ROC curve results showed that the combined detection of Ang-2,cTnI and NT-proBNP in the predicting of ACS prognostic had the highest efficiency,the AUC was 0.934(95%CI:0.900-0.968).Multivariate Logistic regression analysis found that Ang-2 and NT-proBNP levels increased were independent risk factors for MACE occured in ACS patients within 12 months.Conclusion The combined detection of Ang-2,cTnI and NT-proBNP could improve ACS diagnostic and prognostic evaluation efficiency,Ang-2 and NT-proBNP are independent risk factors for MACE occurring in ACS patients within 12 months.