急诊胸痛患者血清hsCRP、CTnI及Mb水平及其临床意义分析

Levels and clinical significance of serum myocardial enzymes hsCRP,CTnI and Mb in patients with emergency chest pain

目的分析急诊胸痛患者血清中超敏C-反应蛋白(hsCRP)、肌钙蛋白(CTn)I、肌红蛋白(Mb)水平及其临床意义。方法回顾性抽取2020年4月-2022年4月新乡市第一人民医院160例急诊胸痛患者的临床资料,根据最终诊断是否为急性冠状动脉综合征(ACS)分为ACS组、非ACS组两个亚组,另抽取30名健康志愿者的相关体检资料进行对照分析,作为对照组。均进行血清hsCRP、CTnI、Mb检测;进一步对ACS组进行危险分层评估,分析血清hsCRP、CTnI、Mb与ACS病情程度的关系,并采用受试者工作特征(ROC)曲线分析血清hsCRP、CTnI、Mb对急诊胸痛患者ACS的诊断价值。结果对照组血清hsCRP、CTnI、Mb含量<非ACS组<ACS组,有统计学差异(P<0.05)。ACS组中,低危患者血清hsCRP、CTnI、Mb含量<中危患者<高危患者,有统计学差异(P<0.05)。血清hsCRP、CTnI、Mb单独检测诊断急诊胸痛患者ACS的ROC曲线下面积分别为0.687、0.701、0.686,均有一定诊断价值;确定其诊断急诊胸痛患者ACS的临界值后,单项检测Mb诊断ACS的灵敏度最高(为77.27%),CTnI诊断ACS的特异性最高(为79.31%),logistic模型方程构建联合诊断ACS公式,联合检测诊断ACS的敏感度显著提高,达86.36%。结论急诊胸痛患者血清hsCRP、CTnI、Mb水平较高,且与ACS及危险分层密切相关,联合检测可提高ACS的早期诊断效能。

Objective To analyze the levels and clinical significance of serum hypersensitive C-reactive protein(hsCRP),troponin(CTn)I and myoglobin(Mb)inpatients with emergency chest pain.Methods The clinical data of 160 patients with emergency chest pain admitted to the hospital from April 2020and April 2022were retrospectively collected.According to final diagnosis,the patients were divided into acute coronary syndrome group and non-ACS group.The relevant physical examination data of 30 healthy volunteers were collected for control analysis,and the volunteers were taken as the control group.Serum hsCRP,CTnl and Mb were detected.The relationship between serum hsCRP,CTnl,Mb and the severity of ACS was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum hsCRP,CTnI and Mb for ACS in patients with emergency chest pain.Results The levels of serum hsCRP,CTnI and Mb increased in order from the control group,the non-ACS group,to the ACS group(P<0.05).In ACS group,the levels of serum hsCRP,CTnl and Mb increased in order from low-risk patients,medium-risk patients to high-risk patients(P<0.05).The areas under ROC curves of serumhsCRP,CTnI or Mb alone to diagnoseACS in patients with emergency chest pain were 0.687,0.701 and 0.686,respectively.After determining the critical value,the sensitivity of Mb to diagnose ACS was the highest(77.27%),and the specificity of CTnlwas the highest(79.31%).The logistic model equation was used to construct a formula for joint diagnosis of ACS,and the sensitivity of joint diagnosis was significantly higher,reaching 86.36%.Conclusion The levels of serumhsCRP,CTnl and Mb in patients with emergency chest pain are high,and they are closely related to ACS and risk stratification.Combined detection can improve the early diagnosis of ACS in patients with emergency chest pain.