12导联动态心电图及IMA、血脂水平与冠心病无症状性心肌缺血的相关分析

Correlation analysis of 12 lead holter monitor,IMA,blood lipid levels and asymptomatic myocardial ischemia in coronary heart disease

目的探讨12导联动态心电图(active electro cardio gram,AECG)及缺血修饰白蛋白(ischemia modified albumin,IMA)、血脂水平与冠心病无症状性心肌缺血(SMI)的相关分析。方法选取2020年1月至2023年1月河南省胸科医院诊治的102例疑似冠心病SMI患者作为研究对象,以冠状动脉造影(CAG)为金标准,经金标准确诊为冠心病无症状心肌缺血共48例;并在CAG确诊前予以AECG及IMA、血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]检测;采用四格表法计算AECG、IMA、血脂诊断冠心病的阳性、阴性预测值;采用logistic回归模型分析AECG及IMA、血脂与冠心病SMI的相关性;采用ROC曲线模型分析AECG、IMA、血脂诊断冠心病SMI的AUC值、敏感度及特异度。结果102例疑似冠心病SMI患者经AECG检查后,阳性预测值为85.71%,阴性预测值为88.68%;经IMA检测后,阳性预测值为62.30%,阴性预测值为75.61%;经血脂检测后,阳性预测值为78.00%,阴性预测值为82.69%。AECG的诊断确诊率高于IMA、血脂(χ^(2)=11.227、19.745,P均<0.001)。阳性组的IMA、TC、TG、LDL-C高于阴性组,而HDL-C低于阴性组(P<0.05)。logistic回归分析显示,AECG、IMA、TC、TG、LDL-C升高和HDL-C下降会对冠心病SMI的发生产生影响(P<0.05)。ROC曲线分析显示,AECG、IMA、血脂诊断冠心病SMI的AUC值分别为(0.873、0.683、0.605,P<0.05);敏感度分别为87.50%、79.20%、72.90%;特异度分别为87.00%、57.40%、48.10%。结论AECG、IMA及血脂诊断冠心病IMA具有较高的效能,且IMA和血脂水平会受冠心病IMA影响而升高。

Objective To explore the correlation between 12 lead active electro cardio gram(AECG),ischemia modified albumin(IMA),blood lipid levels and asymptomatic myocardial ischemia(SMI)in patients with coronary heart disease.Methods From January 2020 to January 2023,102 patients with suspected coronary heart disease(CHD)SMI were selected as the research object.With coronary angiography(CAG)as the gold standard,48 patients were diagnosed as asymptomatic myocardial ischemia of CHD by the gold standard;AECG and IMA,blood lipids[total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),High-density lipoprotein cholesterol(HDL-C)]were detected before the diagnosis of CAG;Calculate the positive and negative predictive values of AECG,IMA,and blood lipids for diagnosing coronary heart disease using the four grid table method;Using logistic regression models to analyze the correlation between AECG,IMA,blood lipids,and coronary heart disease SMI;The Receiver operating characteristic model was used to analyze the AUC value,sensitivity and specificity of AECG,IMA and blood lipids in diagnosing SMI of coronary heart disease.Results After AECG examination,the positive predictive value of 102 suspected coronary heart disease SMI patients was 85.71%,and the negative predictive value was 88.68%;After IMA testing,the positive predictive value was 62.30%,and the negative predictive value was 75.61%;After blood lipid testing,the positive predictive value was 78.00%,and the negative predictive value was 82.69%.The diagnostic accuracy of AECG is higher than that of IMA and blood lipids(χ^(2)=11.227,19.745,both P<0.001).The IMA,TC,TG,and LDL-C of the positive group were higher than those of the negative group,while HDL-C was lower than that of the negative group(P<0.05).logistic regression analysis showed that an increase in AECG,IMA,TC,TG,LDL-C,and a decrease in HDL-C would have an impact on the occurrence of coronary heart disease SMI(P<0.05).Receiver operating characteristic analysis showed that AUC values of AECG,IMA and blood lipid in diagnosing SMI of coronary heart disease were(0.873,0.683,0.605,P<0.05);The sensitivity was 87.50%,79.20%,and 72.90%,respectively;The specificity was 87.00%,57.40%,and 48.10%,respectively.Conclusion AECG,IMA,and blood lipids have high efficacy in diagnosing coronary heart disease IMA,and the levels of IMA and blood lipids are affected by coronary heart disease IMA and increase.