中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2012年
9期
747-752
,共6页
赵月霞%王萌%唐志毅%陈旭%王冬环
趙月霞%王萌%唐誌毅%陳旭%王鼕環
조월하%왕맹%당지의%진욱%왕동배
冠状动脉疾病%肌钙蛋白T%利钠肽,脑%C反应蛋白%ROC曲线
冠狀動脈疾病%肌鈣蛋白T%利鈉肽,腦%C反應蛋白%ROC麯線
관상동맥질병%기개단백T%리납태,뇌%C반응단백%ROC곡선
Coronary disease%Troponin T%Natriuretic peptide,brain%C-reactive protein%ROC curve
目的 探讨肌钙蛋白T(TnT)、N末端利钠肽前体(NT-proBNP)和超敏C反应蛋白(hs-CRP)3项心肌和炎性标志物联合检测在老年人急性冠状动脉综合征(ACS)诊断中的应用价值.方法 收集不稳定型心绞痛(UA)组(49例)、非ST段抬高的心肌梗死(NSTEMI)组(48例)、其他急性心肌梗死(AMI)组(37例)及健康对照组(45例)血清样本,用电化学发光双抗体夹心法检测TnT、NT proBNP,免疫透射比浊法测定hs-CRP；通过绘制受试者工作特征(ROC)曲线和建立Logistic回归模型,分析各指标单独和联合检测在UA、NSTEMI及其他AMI诊断中的价值. 结果 ACS 3组中患者血清TnT(除外UA组)、NT-proBNP和hsCRP水平高于健康对照组(均P＜0.05).TnT、NT proBNP和hs-CRP单独与联合检测ACS各分组中ROC曲线下面积(AUC)最大,分别为UA组:0.583±0.059、0.786±0.047、0.620±0.058和0.787±0.046；NSTEMI组:0.967±0.022、0.978±0.015、0.897±0.032和0.991±0.009;其他AMI组:0.971±0.024、0.961±0.021、0.874±0.043和0.999±0.002,TnT、NT-proBNP和hs CRP联合检测与单独检测相比,ROC曲线下面积均有不同程度的提高.TnT、NT-proBNP和hsCRP单独与联合检测的敏感度和特异性分别为UA组:16.7％、100.0％、54.2％、91.1％、54.2％、75.6％和50.0％ 、95.6％；NSTEMI组:93.5％、100.0％ 、95.7％、97.8％、67.4％、97.8％及95.7％和100.0％;其他AMI组:94.1％、100.0％、91.2％、97.8％、67.8％、97.8％及100.0％、97.8％. 结论 联合检测TnT、NT-proBNP、hs-CRP能改善老年ACS中UA的诊断效果,对于NSTEMI和其他AMI也能使敏感度和特异性达到最优化,但对区分NSTEMI和其他AMI效果不明显.
目的 探討肌鈣蛋白T(TnT)、N末耑利鈉肽前體(NT-proBNP)和超敏C反應蛋白(hs-CRP)3項心肌和炎性標誌物聯閤檢測在老年人急性冠狀動脈綜閤徵(ACS)診斷中的應用價值.方法 收集不穩定型心絞痛(UA)組(49例)、非ST段抬高的心肌梗死(NSTEMI)組(48例)、其他急性心肌梗死(AMI)組(37例)及健康對照組(45例)血清樣本,用電化學髮光雙抗體夾心法檢測TnT、NT proBNP,免疫透射比濁法測定hs-CRP；通過繪製受試者工作特徵(ROC)麯線和建立Logistic迴歸模型,分析各指標單獨和聯閤檢測在UA、NSTEMI及其他AMI診斷中的價值. 結果 ACS 3組中患者血清TnT(除外UA組)、NT-proBNP和hsCRP水平高于健康對照組(均P＜0.05).TnT、NT proBNP和hs-CRP單獨與聯閤檢測ACS各分組中ROC麯線下麵積(AUC)最大,分彆為UA組:0.583±0.059、0.786±0.047、0.620±0.058和0.787±0.046；NSTEMI組:0.967±0.022、0.978±0.015、0.897±0.032和0.991±0.009;其他AMI組:0.971±0.024、0.961±0.021、0.874±0.043和0.999±0.002,TnT、NT-proBNP和hs CRP聯閤檢測與單獨檢測相比,ROC麯線下麵積均有不同程度的提高.TnT、NT-proBNP和hsCRP單獨與聯閤檢測的敏感度和特異性分彆為UA組:16.7％、100.0％、54.2％、91.1％、54.2％、75.6％和50.0％ 、95.6％；NSTEMI組:93.5％、100.0％ 、95.7％、97.8％、67.4％、97.8％及95.7％和100.0％;其他AMI組:94.1％、100.0％、91.2％、97.8％、67.8％、97.8％及100.0％、97.8％. 結論 聯閤檢測TnT、NT-proBNP、hs-CRP能改善老年ACS中UA的診斷效果,對于NSTEMI和其他AMI也能使敏感度和特異性達到最優化,但對區分NSTEMI和其他AMI效果不明顯.
목적 탐토기개단백T(TnT)、N말단리납태전체(NT-proBNP)화초민C반응단백(hs-CRP)3항심기화염성표지물연합검측재노년인급성관상동맥종합정(ACS)진단중적응용개치.방법 수집불은정형심교통(UA)조(49례)、비ST단태고적심기경사(NSTEMI)조(48례)、기타급성심기경사(AMI)조(37례)급건강대조조(45례)혈청양본,용전화학발광쌍항체협심법검측TnT、NT proBNP,면역투사비탁법측정hs-CRP；통과회제수시자공작특정(ROC)곡선화건립Logistic회귀모형,분석각지표단독화연합검측재UA、NSTEMI급기타AMI진단중적개치. 결과 ACS 3조중환자혈청TnT(제외UA조)、NT-proBNP화hsCRP수평고우건강대조조(균P＜0.05).TnT、NT proBNP화hs-CRP단독여연합검측ACS각분조중ROC곡선하면적(AUC)최대,분별위UA조:0.583±0.059、0.786±0.047、0.620±0.058화0.787±0.046；NSTEMI조:0.967±0.022、0.978±0.015、0.897±0.032화0.991±0.009;기타AMI조:0.971±0.024、0.961±0.021、0.874±0.043화0.999±0.002,TnT、NT-proBNP화hs CRP연합검측여단독검측상비,ROC곡선하면적균유불동정도적제고.TnT、NT-proBNP화hsCRP단독여연합검측적민감도화특이성분별위UA조:16.7％、100.0％、54.2％、91.1％、54.2％、75.6％화50.0％ 、95.6％；NSTEMI조:93.5％、100.0％ 、95.7％、97.8％、67.4％、97.8％급95.7％화100.0％;기타AMI조:94.1％、100.0％、91.2％、97.8％、67.8％、97.8％급100.0％、97.8％. 결론 연합검측TnT、NT-proBNP、hs-CRP능개선노년ACS중UA적진단효과,대우NSTEMI화기타AMI야능사민감도화특이성체도최우화,단대구분NSTEMI화기타AMI효과불명현.
Objective To investigate the value of the joint detection of Troponin T(TnT),highsensitivity C-reactive protein (hs-CRP) and N-terminal probrain natriuretic peptide (NT-proBNP) for the clinical diagnosis of acute coronary syndrome(ACS) in elderly patients.Methods The adequate serum samples were collected in each group:unstable angina (UA) (49 cases),non-ST segment elevations myocardial infarction(NSTEMI) (48 cases),acute myocardial infarction(AMI) (37 cases)and healthy control (45 cases).The levels of TnT and NT-proBNP were measured by electrochemiluminescent double antibody sandwich method,and hs CRP by immune transmission turbidity.The roles of individual and joint detection of the three indicators were analyzed by ROC curve and Logistic regression model.Results Except for TnT in UA group,the serum TnT,NT-proBNP and hs-CRP levels were significantly higher in three ACS groups than in healthy control group (P＜0.05).The largest areas under the ROC curve (AUC) of individual TnT,NT-proBNP,hs-CRP testing and the joint detection for UA were 0.583±0.059,0.786±0.047,0.620±0.058 and 0.787±0.046,for NSTEMI were 0.967±0.022,0.978±0.015,0.897±0.032 and 0.991 ±0.009,for AMI were 0.971 ± 0.024,0.961 ± 0.021,0.874 ± 0.043 and 0.999 ± 0.002,therefore,the area under the ROC curve of the joint detection was increased to some degree as compared with individual TnT,NT-proBNP,hs-CRP testing.Similarly,the best sensitivity and specificity of individual TnT,NT-proBNP,hs-CRP testing and the joint detection for UA were 16.7％ and 100.0％,54.2％ and 91.1％,54.2％ and 75.6％,50％ and 95.6％; for NSTEMI were 93.5％ and 100.0％,95.7％ and 97.8％,67.4％ and 97.8％,95.7％ and 100.0％; for AMI were 94.1％ and 100.0％,91.2％ and 97.8％,67.8％ and 97.8％,100.0％ and 97.8％,respectively.Conclusions Joint detection of TnT,NT-proBNP,hs-CRP can significantly improve the diagnosis of UA; for NSTEMI and other AMI,it can be achieved the optimism of sensitivity and specificity,but its effect of distinguishing NSTEMI and AMI is little.
