动态心电图联合血清NT-proBNP、CysC诊断老年冠状动脉粥样硬化性心脏病无症状心肌缺血的价值分析

Value Analysis of Dynamic Electrocardiogram Combined Serum NT-proBNP and Cys C in the Diagnosis of Asymptomatic Myocardial Ischemia in Elderly Patients with Coronary Heart Disease

目的分析动态心电图(dynamic electrocardiogram,DEG)联合血清氨基末端B型脑钠肽前体(nitrogen-terminal B type natriureticpeptide precursor,NT-proBNP)、胱抑素C(cystatinC,CysC)诊断老年冠状动脉粥样硬化性心脏病(以下简称为冠心病)无症状心肌缺血的临床价值。方法83例疑似老年冠心病无症状心肌缺血患者根据冠状动脉造影(coronary arteriography,CAG)检查结果分为CAG阳性组(n=59)和CAG阴性组(n=24)。比较两组患者临床资料、心肌缺血发作持续时间、心肌缺血ST段压低发作时间分布及血清NT-proBNP、CysC表达水平。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析DEG联合血清NT-proBNP、CysC诊断老年冠心病无症状心肌缺血的临床价值。结果两组患者临床资料比较差异无统计学意义(P>0.05)。CAG阳性组患者心肌缺血发作持续时间及血清NT-proBNP、CysC表达水平均高于CAG阴性组,组间比较差异有统计学意义(P均<0.05)。两组患者心肌缺血ST段压低发作时间分布情况比较差异无统计学意义(P>0.05)。DEG联合血清NT-proBNP、CysC诊断老年冠心病无症状心肌缺血的曲线下面积(area under the curve,AUC)、灵敏度及特异度均优于任何单一指标的诊断(P<0.05)。结论DEG联合血清NT-proBNP、CysC诊断老年冠心病无症状心肌缺血具有较好的临床应用价值。

Objective To analyze the clinical value of dynamic electrocardiogram(DEG)combined serum nitrogenterminal B type natriureticpeptide precursor(NT-proBNP)and cystatin C(Cys C)in the diagnosis of asymptomatic myocardial ischemia in elderly patients with coronary heart disease.Methods A total of 83 suspected elderly asymptomatic myocardial ischemia patients with coronary heart disease were divided into the coronary arteriography(CAG)positive group(n=59)and the CAG negative group(n=24)on base of the results of the CAG examination.The clinical data,duration of myocardial ischemia attacks,distribution of ST segment depression attacks and the expression levels of serum NT-proBNP,Cys C between the two groups were compared.The clinical value of DEG combined serum NT-proBNP and Cys C in diagnosing asymptomatic myocardial ischemia in elderly patients with coronary heart disease was analyzed by receiver operating characteristic(ROC)curve.Results There was no statistically significant difference in clinical data between the two groups(P>0.05).The duration of myocardial ischemic attack and the expression levels of serum NT-proBNP,Cys C in the CAG positive group were higher than those in the CAG negative group,with statistical significance(all P<0.05).There was no statistically significant difference in the distribution of ST segment depression onset time between the two groups(P>0.05).The area under the curve(AUC),sensitivity and specificity of DEG combined serum NT-proBNP,Cys C in the diagnosis of asymptomatic myocardial ischemia in elderly coronary heart disease were better than those of any single indicators(P<0.05).Conclusion The combined detection of DEG and serum NT-proBNP,Cys C has a good clinical application value in the diagnosis of asymptomatic myocardial ischemia in elderly patients with coronary heart disease.