甲状旁腺激素联合颈动脉内膜中层厚度对冠状动脉钙化的预测作用

Predictive effect of parathyroid hormone combined with carotid intima-media thickness on coronary artery calcification

目的探讨甲状旁腺激素(PTH)与颈动脉内膜中层厚度(IMT)对冠状动脉钙化(CAC)程度的预测价值。方法回顾性分析2018年12月至2020年3月于大理大学第一附属医院住院的164例疑似冠心病患者的临床资料,根据冠状动脉钙化积分(CACS)分为两组,将CACS等于0分的患者纳入非钙化组(n=63),钙化积分大于0分的患者纳入钙化组(n=101)。分析与CAC有关联的因素及比较不同组间的各指标水平,比较不同组别间PTH及IMT的水平。采用单因素Logistic回归分析分析是否存在CAC的独立危险或保护因素。采用受试者工作特征(ROC)曲线分析PTH、IMT、PTH联合IMT对CAC的预测效能。根据最佳约登指数选取截断值,并分别计算出各截断值所对应的敏感性、特异性等,再根据曲线下面积(AUC)评估诊断效能。结果组间年龄、血糖、PTH、IMT差异具有统计学意义(P<0.05)。与非钙化组相比,钙化组的上述指标水平更高(P<0.05)。重度钙化组的PTH水平高于中度钙化组、轻度钙化组及少量钙化组,中度钙化组的PTH水平高于轻度及少量钙化组,差异有显著的统计学意义(P<0.01),但在不同钙化程度组之间,IMT并无明显的统计学意义。以PTH、IMT水平为检验变量、冠状动脉动脉钙化为状态变量绘制ROC曲线,得出PTH+IMT作为预测因素效果最佳,其次为PTH,最后为IMT。对ROC曲线分析后得出当PTH大于77 pg/ml时,CAC可能性较大;当IMT大于0.98 mm时,CAC可能性也较大。进行三者ROC曲线下面积分析后,提示三者均可预测CAC。三者两两对比分析预测价值后提示PTH联合IMT的预测价值优于单个指标预测。绘制PTH、IMT及PTH联合IMT的ROC曲线,若AUC>0.7时,认定具有一定预测效能。若AUC>0.9时,认定具有较佳的预测效能。结论PTH对CAC的预测作用明显高于IMT的预测作用;PTH联合IMT的预测作用高于PTH单独的预测作用,PTH联合IMT的预测作用明显高于IMT单独的预测作用。PTH联合IMT的预测价值分别优于单个指标价值。可供临床参考。

Objective To explore the predictive value of parathyroid hormone(PTH)and carotid intima-media thickness(IMT)on the degree of coronary artery calcification(CAC).Methods The clinical data of 164 patients with suspected coronary heart disease hospitalized in the First Affiliated Hospital of Dali University from December 2018 to March 2020 were retrospectively analyzed.According to the coronary artery calcification score(CACS),the patients were allocated to non-calcification group(CACS=0,n=63)and the calcification group(CACS>0,n=101).CAC-associated factors were identified.Clinical data between different groups were compared,including PTH and IMT.Independent risk or protective factors for CAC were identified by univariable logistic regression analysis.The predictive efficacy of PTH,IMT and their combination on CAC was analyzed by plotting the receiver operating characteristic(ROC)curves.The cut-off value was determined based on the Youden index,and the corresponding specificity and sensitivity were calculated.The area under the curve(AUC)was calculated to assess the diagnostic potential.Results There were significant differences in age,blood glucose,PTH and IMT between the groups(P<0.05).Compared with the non-calcification group,the levels of the above indicators in the calcification group were significantly higher(P<0.05).The PTH level in the severe calcification group was significantly higher than that in the moderate,mild and lesscalcification groups,and the PTH level in the moderate calcification group was significantly higher than that in the mild and lesscalcification groups(P<0.01).There was no significant difference in IMT among groups(P>0.05).The ROC curves were plotted with PTH and IMT as test variables and CAC as state variable.The combination detection of PTH and IMT presented the best diagnostic potential in CAC,followed by the single detection of PTH,and IMT.When PTH was greater than 77 pg/ml,the possibility of CAC was greater.When IMT was greater than 0.98 mm,the possibility of CAC was also greater.After calculating AUC,PTH,IMT and their combination were all able to predict CAC.The pairwise comparison showed that the diagnostic potential of the combination detection of PTH and IMT was superior to their single detection.ROC curves of PTH,IMT and their combination were drawn.AUC>0.7 suggested a certain predictive effect,and AUC>0.9 suggested an acceptable predictive value.Conclusion The predictive effect of PTH on CAC is significantly higher than that of IMT.The predictive effect of PTH combined with IMT is higher than that of PTH or IMT alone.It can be used for clinical reference.