血清同型半胱氨酸、胱抑素C、脂蛋白a及高敏C反应蛋白检测对急性心肌梗死的早期诊断价值

Value of serum homocysteine,cystatin C,lipoprotein a and hypersensitive C-reactive protein in early diagnosis of acute myocardial infarction

目的采用受试者工作特征曲线(ROC)研究血清同型半胱氨酸(Hcy)、胱抑素C(Cys C)、脂蛋白a[Lp(a)]以及高敏C反应蛋白(hs-CRP)水平的检测对急性心肌梗死(AMI)患者的早期诊断价值。方法选取2019年9月至2021年4月于福建省立医院南院住院的126例行冠状动脉造影的患者作为研究对象,按照检查结果将其分为AMI组(60例)与无心血管系统相关疾病的对照组(66例)。比较两组患者血清中的Hcy、Cys C、Lp(a)及hs-CRP水平,采用ROC曲线分析Hcy、Cys C、Lp(a)、hs-CRP四项指标单独及联合检测的曲线下面积(AUC)、最佳截断值、灵敏度、特异度以及约登指数。结果AMI组患者的Hcy、Cys C、Lp(a)及hs-CRP水平均高于对照组,差异有统计学意义(P<0.05)。Hcy、Cys C、Lp(a)、hs-CRP单独及联合诊断AMI早期的AUC分别为0.94、0.86、0.87、0.81、0.99,其中hs-CRP的最佳截断值为1.83 mg/L,约登指数为0.76。四项联合检测的约登指数为0.92。结论Hcy、Cys C、Lp(a)及hs-CRP对AMI早期诊断均有较好价值,其中hs-CRP的诊断价值最高。将四项指标联合检测用于AMI早期诊断较各项目单独检测具有更好的诊断价值。

Objective To investigate the early diagnostic value of serum homocysteine(Hcy),cystatin C(Cys C),lipoprotein a(Lp[a])and high sensitivity C-reactive protein(hs-CRP)in patients with acute myocardial infarction(AMI)by receiver operating characteristic curve(ROC).Methods A total of 126 patients who underwent coronary angiography in the South Branch of Fujian Provincial Hospital from September 2019 to April 2021 were selected as the research objects.According to the examination results,they were divided into the AMI group(60 cases)and the control group(66 cases)without cardiovascular diseases.The serum levels of Hcy,Cys C,Lp(a)and hs-CRP in the two groups were compared.The area under curve(AUC),optimal cut-off value,sensitivity,specificity and Yorden index of Hcy,Cys C,Lp(a)and hs-CRP were analyzed by ROC curve.Results The levels of Hcy,Cys C,Lp(a)and hs-CRP in the AMI grup were higher than those in the control group,and the differences were statistically significant(P<0.05).The AUC of Hcy,Cys C,Lp(a)and hs-CRP were 0.94,0.86,0.87,0.81 and 0.99 respectively in the early diagnosis of AMI,in which the optimal cut-off value of hs-CRP was 1.83 mg/L and the Yoden index was 0.76.The combined four measures Jorden index was 0.92.Conclusion Hcy,Cys C,Lp(a)and hs-CRP have good value in early diagnosis of AMI,and hs-CRP has the highest value.The combined detection of the four indexes in early diagnosis of AMI has better diagnostic value than each item alone.