动态心电图联合血清IMA、GRP78、miR-29a诊断冠心病心肌缺血的临床价值

Clinical value of holter electrocardiogram combined with serum IMA,GRP78 and miR-29a in the diagnosis of myocardial ischemia in coronary heart disease

目的前瞻性研究动态心电图(DCG)联合血清缺血修饰白蛋白(IMA)、葡萄糖调节蛋白78(GRP78)、微小RNA-29a(miR-29a)诊断冠心病心肌缺血的临床价值。方法回顾性选择2020年7月至2022年8月于宿迁市第一人民医院就诊的冠心病心肌缺血患者100例,按照冠脉病变支分为单支组(n=67)、多支组(n=33),两组均行DCG联合血清IMA、GRP78、miR-29a检查。观察两组DCG特征;血清IMA、GRP78、miR-29a水平。以冠脉造影诊断结果为金标准,评价DCG及血清IMA、GRP78、miR-29a单独、联合诊断冠心病心肌缺血的诊断效能。分析冠心病心肌缺血患者DCG特征及血清IMA、GRP78、miR-29a水平与冠心病心肌缺血的病变程度相关性。结果单支组ST段压低幅度、ST段压低持续时间、心肌缺血发作频次分别为(1.41±0.16)mm、(7.82±0.80)min、(2.04±0.22)次、均小于多支组[(3.42±0.36)mm]、(17.13±1.93)min、(4.32±0.45)次],差异均有统计学意义(P<0.05)。单支组血清IMA水平为(13.29±1.60)U/mL,高于多支组[(7.34±0.76)U/mL],血清GRP78、miR-29a水平分别为(1.32±0.12)ng/mL、1.84±0.21,均低于单支组[(2.26±0.24)ng/mL、3.95±0.42],差异均有统计学意义(P<0.05)。以冠脉造影诊断结果为金标准,DCG及血清IMA、GRP78、miR-29a四者联合诊断冠心病心肌缺血的敏感度、特异度、阳性预测值及阴性预测值均高于四者单独、两两及三三联合诊断(P<0.05)。经Pearson相关性分析,ST段压低幅度、ST段压低持续时间、心肌缺血发作频次及血清GRP78、miR-29a水平与冠心病心肌缺血不同病变程度呈正相关(r=0.812、0.737、0.713、0.594、0.686,P<0.05),血清IMA水平与冠心病心肌缺血不同病变程度呈负相关(r=-0.521,P<0.05)。结论DCG联合血清IMA、GRP78、miR-29a可提高对冠心病心肌缺血的诊断效能。

Objective To prospectively investigate the clinical value of Dynamic electrocardiogram(DCG)combined with serum Ischemia-modified albumin(IMA),Glucose-regulatory protein 78(GRP78)and micrnas 29a(miR-29a)in the diagnosis of myocardial ischemia in coronary heart disease.Methods A total of 100 patients with CHD-MI who were treated in Suqian First Hospital from July 2020 to August 2022 were selected and divided into the single branch group(n=67)and the multi-branch group(n=33)according to coronary artery lesion branches.DCG combined with serum IMA,GRP78 and miR-29a were examined in both groups.The DCG characteristics of two groups were observed.Serum IMA,GRP78,miR-29a levels.The diagnostic efficacy of DCG and serum IMA,GRP78 and miR-29a in the diagnosis of myocardial ischemia in coronary heart disease alone or in combination was evaluated using the results of coronary angiography as the gold standard.The correlation between DCG characteristics and serum IMA,GRP78,miR-29a levels in myocardial ischemia in coronary heart disease patients and the degree of CHD-MI lesions was analyzed.Results The ST segment depression amplitude,ST segment depression duration and frequency of myocardial ischemic attack in the single brach group were(1.41±0.16)mm,(7.82±0.80)min,(2.04±0.22)times,which were lower than those in the multi-brach group[(3.42±0.36)mm,(17.13±1.93)min,(4.32±0.45)times],the differences were statistically significant(P<0.05).The level of serum IMA in the single brach group was(13.29±1.60)U/mL,which was higher than that in the multi-brach group[(7.34±0.76)U/mL],the levels of serum GRP78 and miR-29a were(1.32±0.12)ng/mL,1.84±0.21,which were lower than those in the single brach group[(2.26±0.24)ng/mL,3.95±0.42],the differences were statistically significant(P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of DCG combined with IMA,GRP78 and miR-29a in the diagnosis of myocardial ischemia in coronary heart disease were higher than those of DCG combined with IMA,GRP78 and Mir-29A alone using the results of coronary angiography as the gold standard(P<0.05).Pearson correlation analysis showed that ST segment depression amplitude,ST segment depression duration,frequency of myocardial ischemic attack and serum GRP78 and miR-29a levels were positively correlated with different degrees of myocardial ischemia in coronary heart disease lesions(r=0.812,0.737,0.713,0.594,0.686,P<0.05).Serum IMA level was negatively correlated with CHD-MI lesion degree(r=-0.521,P<0.05).Conclusion DCG combined with IMA,GRP78 and miR-29a can improve the diagnostic efficiency of myocardial ischemia in coronary heart disease.