心肌标志物联合检测对血液透析患者并发心血管疾病的诊断价值

Diagnostic value of combined detection of myocardial markers for cardiovascular disease in hemodialysis patients

目的探讨心肌标志物联合检测对维持性血液透析(MHD)患者并发心血管疾病的诊断价值。方法将2020年1月1日至2021年12月31日于该院血液透析中心治疗的患者共205例纳入研究。根据是否并发心血管疾病,将205例患者分为无心血管疾病组(92例)和心血管疾病组(113例)。从临床检查结果中收集患者的检测数据。通过访谈及调查问卷获得患者基本资料。检测纳入研究者血清可溶性生长刺激表达基因2蛋白(sST2)、血清氨基末端脑利钠肽前体(NT-proBNP)、肌钙蛋白T(TNT)、肌红蛋白(MYO)水平。通过超声心动图检测患者左室射血分数(LVEF%)。比较两组患者基本资料和血清标志物水平。对纽约心脏协会(NYHA)分级与各项指标的相关性进行分析。对MHD患者并发心血管疾病的危险因素近分析。采用受试者工作特征(ROC)曲线分析不同心肌标志物对MHD患者并发心血管疾病的诊断效能。采用随机森林法对3种心肌标志物的诊断效能进行比较。采用R语言进行分析,评估不同心肌标志物组合的检测对MHD患者并发心血管疾病诊断的效能。结果心血管疾病组年龄、糖尿病史比例、开始透析年龄,NT-proBNP、sST2、TNT、MYO水平较无心血管疾病组更高(P<0.05),透析时间更短(P<0.05),BUN、LVEF%更低(P<0.05)。年龄、NT-proBNP、sST2与NYHA分级呈正相关(r=0.280、0.292、0.401,P<0.05)。年龄和sST2是并发心血管疾病的独立危险因素(P<0.05)。NT-proBNP、sST2、TNT 3项指标中,sST2是最重要的变量(P<0.05)。联合检测的3种组合中,TNT、NT-proBNP和sST2的诊断效能最好。结论sST2诊断性能较好,用于MHD患者并发心血管疾病的诊断优势明显,TNT、NT-proBNP和sST2联合检测在MHD患者心血管疾病诊断中的应用价值较高。

Objective To investigate the diagnostic value of combined detection of myocardial markers for cardiovascular disease in maintenance hemodialysis(MHD)patients.Methods A total of 205 patients treated in the hemodialysis center of the hospital from January 1,2020 to December 31,2021 were enrolled in the study.According to the presence or absence of cardiovascular disease,205 patients were divided into non-cardiovascular disease group(92 cases)and cardiovascular disease group(113 cases).The test data of the patients were collected from the clinical examination results.The basic information of patients was obtained through interviews and questionnaires.The levels of serum soluble growth stimulating-expression gene 2 protein(sST2),N-terminal B-type natriuretic peptide(NT-proBNP),troponin T(TNT)and myoglobin(MYO)were detected.Left ventricular ejection fraction(LVEF%)was measured by echocardiography.The basic data and serum markers were compared between the two groups.The correlation between New York Heart Association(NYHA)classification and various indicators was analyzed.The risk factors of cardiovascular disease in MHD patients were analyzed.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of different myocardial markers for cardiovascular diseases in MHD patients.Random forest method was used to compare the diagnostic efficacy of the three cardiac markers.R language was used for analysis to evaluate the efficacy of different combinations of myocardial markers in the diagnosis of cardiovascular disease in MHD patients.Results Compared with the non-cardiovascular disease group,the cardiovascular disease group had older age,higher proportion of diabetes,older age of initiation of dialysis,higher levels of NT-proBNP,sST2,TNT,and MYO(P<0.05),shorter dialysis time(P<0.05),and lower BUN and LVEF%(P<0.05).Age,NT-proBNP and sST2 were positively correlated with NYHA classification(r=0.280,0.292,0.401,P<0.05).Age and sST2 were independent risk factors for cardiovascular disease(P<0.05).Among the three indicators of NT-proBNP,sST2 and TNT,sST2 was the most important variable(P<0.05).TNT,NT-proBNP and sST2 had the best diagnostic efficacy among the three detection combinations.Conclusion sST2 has good diagnostic performance,and has obvious advantages in the diagnosis of cardiovascular diseases in MHD patients.The combined detection of TNT,NT-proBNP and sST2 has a high application value in the diagnosis of cardiovascular diseases in MHD patients.