超声心动图联合胆红素、Lpa及Hcy检测在冠心病中的诊断价值

Diagnostic value of echocardiography combined with bilirubin,Lpa,and Hcy detection in coronary heart disease

目的探讨超声心动图联合胆红素、脂蛋白a(Lpa)及同型半胱氨酸(Hcy)检测对冠心病(CHD)的诊断价值。方法收集2021年1月至2023年1月成都市新都区人民医院收治的120例CHD患者的临床资料,其中冠脉轻度狭窄者42例,中度狭窄者55例,重度狭窄者23例。另选取同期在本院体检的健康者86名作为对照组。比较两组、CHD不同冠脉狭窄程度患者超声心动图参数及直接胆红素(DBIL)、Lpa、Hcy水平;采用Pearson检验分析超声心动图参数及DBIL、Lpa、Hcy与冠脉狭窄程度的关系;绘制ROC曲线分析超声心动图及DBIL、Lpa、Hcy水平对CHD的诊断效果。结果CHD组左室射血分数(LVEF)、DBIL值均低于对照组,左室舒张末期容积(LVEDV)及左室收缩末期容积(LVESV)、Lpa及Hcy值高于对照组,差异均有统计学意义(P<0.05)。不同冠脉狭窄程度CHD患者LVEF、DBIL值比较:轻度狭窄组>中度狭窄组>重度狭窄组,LVEDV、LVESV、Lpa及Hcy值比较:轻度狭窄组<中度狭窄组<重度狭窄组,差异均有统计学意义(P<0.05)。LVEF、DBIL值与冠脉狭窄程度呈负相关关系(P<0.05),LVEDV、LVESV、Lpa及Hcy值与冠脉狭窄程度呈正相关关系(P<0.05)。ROC曲线显示,联合诊断(DBIL+Lpa+Hcy+超声心动图)的AUC为0.927(95%CI为0.875~0.969),诊断敏感度和特异度分别为0.918、0.817,高于各指标单一诊断(P<0.05)。结论超声心动图参数及DBIL、Lpa、Hcy在CHD中存在异常表达,联合上述指标可有效诊断CHD,提高诊断效能。

Objective To explore the diagnostic value of echocardiography combined with detection of bilirubin,lipoprotein A(Lpa),and homocysteine(Hcy)in coronary heart disease(CHD).Methods The clinical data of 120 patients with CHD admitted to our hospital from January 2021 to January 2023 were collected,including 42 patients with mild coronary stenosis,55 patients with moderate coronary stenosis,and 23 patients with severe coronary stenosis.Another 86 healthy individuals who underwent physical examination in our hospital during the same period were selected as the control group.Comparison of echocardiographic parameters and direct bilirubin(DBIL),Lpa,and Hcy levels between two groups of patients with different degrees of coronary stenosis in CHD were performed.Pearson test was used to analyze the relationship between echocardiographic parameters,DBIL,lipoprotein a,and Hcy,and the degree of coronary stenosis.The ROC curve was drawn to analyze the diagnostic effect of echocardiography and DBIL,Lpa,Hcy levels on CHD.Results The left ventricular ejection fraction(LVEF)and DBIL values in the CHD group were lower than those in the control group,while the left ventricular end⁃diastolic volume(LVEDV)and left ventricular end⁃systolic volume(LVESV),Lpa,and Hcy values were higher than those in the control group,with statistical significance(P<0.05).Comparison of LVEF and DBIL values among CHD patients with different degrees of coronary stenosis:mild stenosis group>moderate stenosis group>severe stenosis group;comparison of LVEDV,LVESV,Lpa,and Hcy values:mild stenosis group<moderate stenosis group<severe stenosis group,with statistically significant differences(P<0.05).LVEF and DBIL values were negatively correlated with the degree of coronary stenosis(P<0.05),while LVEDV,LVESV,Lpa,and Hcy values were positively correlated with the degree of coronary stenosis(P<0.05).The ROC curve shows that the AUC of the combined diagnosis(DBIL+Lpa+Hcy+echocardiography)is 0.927(95%CI,0.875⁃0.969),with diagnostic sensitivity and specificity of 0.918 and 0.817,respectively,which are higher than the single diagnosis of each indicator(P<0.05).Conclusions Echocardiographic parameters and abnormal expressions of DBIL,Lpa,and Hcy are present in CHD.Combining the above indicators can effectively diagnose CHD and improve diagnostic efficiency.