CT血管造影联合血清缺血修饰白蛋白、前白蛋白水平对心肌梗死与心肌缺血的鉴别诊断价值
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摘要
目的分析CT血管造影(CTA)联合血清缺血修饰白蛋白(IMA)、前白蛋白(PA)水平对心肌梗死与心肌缺血的鉴别诊断价值。方法选取2015年12月—2017年12月扬州友好医院心内科收治的冠心病患者56例,根据冠状动脉造影结果分为心肌缺血组32例,心肌梗死组24例。所有患者行CTA检查,并检测血清IMA、PA水平。比较两组患者血清IMA、PA水平;列出四格表以评价CTA、血清IMA、PA水平及其联合对心肌梗死与心肌缺血的鉴别诊断价值,绘制ROC曲线以评价CTA+IMA、CTA+PA及CTA+IMA+PA平行试验、系列试验对心肌梗死与心肌缺血的鉴别诊断价值。结果 (1)心肌梗死组患者血清IMA水平高于心肌缺血组,血清PA水平低于心肌缺血组(P<0.05)。(2)CTA鉴别诊断心肌梗死与心肌缺血的灵敏度为79.2%,特异度为46.9%,约登指数为26.1%;血清IMA水平鉴别诊断心肌梗死与心肌缺血的灵敏度为66.7%,特异度为53.1%,约登指数为19.8%;血清PA水平鉴别诊断心肌梗死与心肌缺血的灵敏度为66.7%,特异度为78.1%,约登指数为44.8%。(3)CTA+IMA平行试验鉴别诊断心肌梗死与心肌缺血的灵敏度为79.2%,特异度为68.8%,约登指数为48.0%;CTA+PA平行试验鉴别诊断心肌梗死与心肌缺血的灵敏度为66.7%,特异度为81.3%,约登指数为48.0%;CTA+IMA+PA平行试验鉴别诊断心肌梗死与心肌缺血的灵敏度为70.8%,特异度为93.8%,约登指数为64.6%。CTA+IMA系列试验鉴别诊断心肌梗死与心肌缺血的灵敏度为83.3%,特异度为40.6%,约登指数为23.9%;CTA+PA系列试验鉴别诊断心肌梗死与心肌缺血的灵敏度为75.0%,特异度为46.9%,约登指数为21.9%;CTA+IMA+PA系列试验鉴别诊断心肌梗死与心肌缺血的灵敏度为100.0%,特异度为59.4%,约登指数为59.4%。(4)绘制ROC曲线发现,CTA+IMA+PA平行试验鉴别诊断心肌梗死与心肌缺血的AUC大于CTA+IMA+PA系列试验(P<0.05)。结论 CTA联合血清IMA、PA水平对心肌梗死与心肌缺血的鉴别诊断价值较高,且三者平行试验鉴别诊断价值高于系列试验。
Objective To analyze the differential diagnostic value of CT angiography combined with serum levels of IMA and PA between myocardial infarction and myocardial ischemia. Methods A retrospective analysis was made on 56 patients with coronary heart disease who were treated in Friendliness Hospital of Yangzhou from December 2015 to December 2017. Data of CTA,serum levels of IMA and PA were collected. According to coronary angiography examination results,all of the 56 patients were divided into myocardial ischemia group(n=32)and myocardial infarction group(n=24). Intergroup comparisons of serum levels of IMA and PA were performed. Differential diagnostic value of CTA,serum levels of IMA and PA,and combination of above three were evaluated by quadruple table between myocardial infarction and myocardial ischemia;ROC curves were drawn to assess differential diagnostic value of parallel and serial test of CTA+IMA,CTA+PA and CTA+IMA+PA between myocardial infarction and myocardial ischemia. Results(1)Myocardial infarction group showed higher serum IMA level but lower serum PA level compared with myocardial ischemia group(P<0.05).(2)For the differential diagnostic value between myocardial infarction and myocardial ischemia,the sensitivity,specificity and Youden's index of CTA was 79.2%,46.9% and 26.1%,respectively,that of serum IMA level was 66.7%,53.1% and 19.8%,respectively,and that of serum PA level was 66.7%,78.1% and 44.8%,respectively.(3)For the differential diagnostic value between myocardial infarction and myocardial ischemia,the sensitivity,specificity and Youden's index of parallel test of CTA+IMA was 79.2%,68.8% and 48.0%,respectively,that of parallel test of CTA+PA was 66.7%,81.3% and 48.0%,respectively,and that of parallel test of CTA+IMA+PA was 70.8%,93.8% and 64.6%,respectively;the sensitivity,specificity and Youden's index of serial test of CTA+IMA was 83.3%,40.6% and 23.9%,respectively,that of serial test of CTA+PA was 75.0%,46.9% and 21.9%,respectively,and that of serial test CTA+IMA+PA was 100.0%,59.4% and 59.4%,respectively.(4)ROC curves showed that,AUC of parallel test of CTA,serum levels of IMA and PA was statistically significantly greater than that of serial test of the above three(P<0.05). Conclusion Combination of CTA,serum levels of IMA and PA has significantly higher differential diagnostic value between myocardial infarction and myocardial ischemia than the above three used alone,and parallel test of the above demonstrated a higher differential diagnostic value than serial test.
Objective To analyze the differential diagnostic value of CT angiography combined with serum levels of IMA and PA between myocardial infarction and myocardial ischemia. Methods A retrospective analysis was made on 56 patients with coronary heart disease who were treated in Friendliness Hospital of Yangzhou from December 2015 to December 2017. Data of CTA,serum levels of IMA and PA were collected. According to coronary angiography examination results,all of the 56 patients were divided into myocardial ischemia group(n=32)and myocardial infarction group(n=24). Intergroup comparisons of serum levels of IMA and PA were performed. Differential diagnostic value of CTA,serum levels of IMA and PA,and combination of above three were evaluated by quadruple table between myocardial infarction and myocardial ischemia;ROC curves were drawn to assess differential diagnostic value of parallel and serial test of CTA+IMA,CTA+PA and CTA+IMA+PA between myocardial infarction and myocardial ischemia. Results(1)Myocardial infarction group showed higher serum IMA level but lower serum PA level compared with myocardial ischemia group(P<0.05).(2)For the differential diagnostic value between myocardial infarction and myocardial ischemia,the sensitivity,specificity and Youden's index of CTA was 79.2%,46.9% and 26.1%,respectively,that of serum IMA level was 66.7%,53.1% and 19.8%,respectively,and that of serum PA level was 66.7%,78.1% and 44.8%,respectively.(3)For the differential diagnostic value between myocardial infarction and myocardial ischemia,the sensitivity,specificity and Youden's index of parallel test of CTA+IMA was 79.2%,68.8% and 48.0%,respectively,that of parallel test of CTA+PA was 66.7%,81.3% and 48.0%,respectively,and that of parallel test of CTA+IMA+PA was 70.8%,93.8% and 64.6%,respectively;the sensitivity,specificity and Youden's index of serial test of CTA+IMA was 83.3%,40.6% and 23.9%,respectively,that of serial test of CTA+PA was 75.0%,46.9% and 21.9%,respectively,and that of serial test CTA+IMA+PA was 100.0%,59.4% and 59.4%,respectively.(4)ROC curves showed that,AUC of parallel test of CTA,serum levels of IMA and PA was statistically significantly greater than that of serial test of the above three(P<0.05). Conclusion Combination of CTA,serum levels of IMA and PA has significantly higher differential diagnostic value between myocardial infarction and myocardial ischemia than the above three used alone,and parallel test of the above demonstrated a higher differential diagnostic value than serial test.
引文
[1]龙邦媛,卢小军,王庆平,等.64排128层螺旋CT冠脉成像与冠状动脉造影在高龄冠心病患者冠状动脉狭窄病变诊断中的对比[J].中国老年学杂志,2016,36(16):4040-4042.DOI:10.3969/j.issn.1005-9202.2016.16.082
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[4]李永忠.冠状动脉CT血管造影与平板运动试验在冠心病诊断中的应用分析[J].中国慢性病预防与控制,2015,23(2):145-146.
[5]MONDA C,HALDER A K,ADHIKARI N,et al.Cholesteryl ester transfer protein inhibitors in coronary heart disease:Validated comparative QSAR modeling of N,N-disubstituted trifluoro-3-amino-2-propanols[J].Comput Biol Med,2013,43(10):1545-1555.DOI:10.1016/j.compbiomed.2013.07.034.
[6]BOVENSCHULTEH,KRUGB,SCHNEIDERT,etal.CT coronary angiography:Coronary CT-flow quantification supplements morphological stenosis analysis[J].Eur J Radiol,2013,82(4):608-616.DOI:10.1016/j.ejrad.2012.08.004.
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[8]肖平喜,谭明娟,万芳,等.血清缺血修饰白蛋白在冠心病患者中的临床应用价值[J].标记免疫分析与临床,2017,24(4):374-377.DOI:10.11748/bjmy.issn.1006-1703.2017.04.004.
[9]闫宗凤,袁宇.冠状动脉粥样硬化性心脏病患者血清尿酸、前白蛋白和胱抑素C水平变化及临床意义[J].新乡医学院学报,2015,32(5):452-455.DOI:10.7683/xxyxyxb.2015.05.022.
[10]杨朝美,李逊,马珍.血清BNP、hs-CRP、IMA与冠状动脉粥样硬化性心脏病患者的相关性研究[J].中国实验诊断学,2015,11(7):1077-1079.
[11]郑思道,杨翠.冠心病患者贫血的发病原因、治疗及预后研究进展[J].实用心脑肺血管病杂志,2018,26(10):1-5.DOI:10.3969/j.issn.1008-5971.2018.10.001.
[12]贺春霞,杨晶晶,袁美锦,等.门诊老年冠心病合并糖尿病患者血清BDNF变化、血脂检验及行PCl治疗观察[J].海南医学院学报,2016,22(16):1921-1924.DOI:10.13210/j.cnki.jhmu.20160806.001.
[13]PRASHANTH A K,ANAND U.Clinical significance of ischemia modified albumin in critically iII patients with sepsis[J].Indian J Clin Biochem,2015,30(2):194-197.DOI:10.1007/s12291-014-0434-4.
[14]张文兴,朱莉.ST段抬高型心肌梗死治疗的研究进展[J].实用心脑肺血管病杂志,2017,25(10):4-7.DOI:10.3969/j.issn.1008-5971.2017.10.002.
[15]马网霞,李家一.冠状动脉造影结果正常的临床诊断为急性冠脉综合征患者的病因分析[J].实用心脑肺血管病杂志,2018,26(1):92-94.DOI:10.3969/j.issn.1008-5971.2018.01.023.
[16]李秀丽,邵静波,张银环,等.血清缺血修饰蛋白检测对冠心病诊疗的临床价值[J].山东医药,2015,14(5):85-86.DOI:10.3969/j.issn.1002-266X.2015.05.034.
[17]刘贵京,苏曼,袁江永,等.扩张型心肌病患者血清缺血修饰白蛋白水平变化及其临床意义研究[J].实用心脑肺血管病杂志,2018,26(1):27-30.
[18]杨军,周松柏,罗健,等.急性冠脉综合征患者外周血CP、IMA和hs-CRP水平的变化及相关性研究[J].中国医药科学,2015,15(12):7-9.
[19]CABASSI A,CHAMPLAIN J D,MAGGIORE U,et al.Prealbumin improves death risk prediction of BNP-added Seattle Heart Failure Model:Results from a pilot study in elderly chronic heart failure patients[J].Int J Cardiol,2013,168(4):3334-3339.DOI:10.1016/j.ijcard.2013.04.039.
[20]CACCIALANZA R,PALLADINI G,KLERSY C,et al.Serum prealbumin:An independent marker of short-term energy intake in the presence of multiple-organ disease involvement[J].Nutrition,2013,29(3):580-582.DOI:10.1016/j.nut.2012.08.007.
[2]齐杰.128层螺旋CT冠脉成像与选择性冠脉造影在冠心病诊断中的应用价值比较分析[J].湖南师范大学学报(医学版),2015,12(4):107-109.
[3]丁辉.64排螺旋CT冠脉成像(CTA)在冠心病诊断中的应用价值分析[J].中国实验诊断学,2016,13(2):224-226.
[4]李永忠.冠状动脉CT血管造影与平板运动试验在冠心病诊断中的应用分析[J].中国慢性病预防与控制,2015,23(2):145-146.
[5]MONDA C,HALDER A K,ADHIKARI N,et al.Cholesteryl ester transfer protein inhibitors in coronary heart disease:Validated comparative QSAR modeling of N,N-disubstituted trifluoro-3-amino-2-propanols[J].Comput Biol Med,2013,43(10):1545-1555.DOI:10.1016/j.compbiomed.2013.07.034.
[6]BOVENSCHULTEH,KRUGB,SCHNEIDERT,etal.CT coronary angiography:Coronary CT-flow quantification supplements morphological stenosis analysis[J].Eur J Radiol,2013,82(4):608-616.DOI:10.1016/j.ejrad.2012.08.004.
[7]葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013.
[8]肖平喜,谭明娟,万芳,等.血清缺血修饰白蛋白在冠心病患者中的临床应用价值[J].标记免疫分析与临床,2017,24(4):374-377.DOI:10.11748/bjmy.issn.1006-1703.2017.04.004.
[9]闫宗凤,袁宇.冠状动脉粥样硬化性心脏病患者血清尿酸、前白蛋白和胱抑素C水平变化及临床意义[J].新乡医学院学报,2015,32(5):452-455.DOI:10.7683/xxyxyxb.2015.05.022.
[10]杨朝美,李逊,马珍.血清BNP、hs-CRP、IMA与冠状动脉粥样硬化性心脏病患者的相关性研究[J].中国实验诊断学,2015,11(7):1077-1079.
[11]郑思道,杨翠.冠心病患者贫血的发病原因、治疗及预后研究进展[J].实用心脑肺血管病杂志,2018,26(10):1-5.DOI:10.3969/j.issn.1008-5971.2018.10.001.
[12]贺春霞,杨晶晶,袁美锦,等.门诊老年冠心病合并糖尿病患者血清BDNF变化、血脂检验及行PCl治疗观察[J].海南医学院学报,2016,22(16):1921-1924.DOI:10.13210/j.cnki.jhmu.20160806.001.
[13]PRASHANTH A K,ANAND U.Clinical significance of ischemia modified albumin in critically iII patients with sepsis[J].Indian J Clin Biochem,2015,30(2):194-197.DOI:10.1007/s12291-014-0434-4.
[14]张文兴,朱莉.ST段抬高型心肌梗死治疗的研究进展[J].实用心脑肺血管病杂志,2017,25(10):4-7.DOI:10.3969/j.issn.1008-5971.2017.10.002.
[15]马网霞,李家一.冠状动脉造影结果正常的临床诊断为急性冠脉综合征患者的病因分析[J].实用心脑肺血管病杂志,2018,26(1):92-94.DOI:10.3969/j.issn.1008-5971.2018.01.023.
[16]李秀丽,邵静波,张银环,等.血清缺血修饰蛋白检测对冠心病诊疗的临床价值[J].山东医药,2015,14(5):85-86.DOI:10.3969/j.issn.1002-266X.2015.05.034.
[17]刘贵京,苏曼,袁江永,等.扩张型心肌病患者血清缺血修饰白蛋白水平变化及其临床意义研究[J].实用心脑肺血管病杂志,2018,26(1):27-30.
[18]杨军,周松柏,罗健,等.急性冠脉综合征患者外周血CP、IMA和hs-CRP水平的变化及相关性研究[J].中国医药科学,2015,15(12):7-9.
[19]CABASSI A,CHAMPLAIN J D,MAGGIORE U,et al.Prealbumin improves death risk prediction of BNP-added Seattle Heart Failure Model:Results from a pilot study in elderly chronic heart failure patients[J].Int J Cardiol,2013,168(4):3334-3339.DOI:10.1016/j.ijcard.2013.04.039.
[20]CACCIALANZA R,PALLADINI G,KLERSY C,et al.Serum prealbumin:An independent marker of short-term energy intake in the presence of multiple-organ disease involvement[J].Nutrition,2013,29(3):580-582.DOI:10.1016/j.nut.2012.08.007.