循证医学
循證醫學
순증의학
THE JOURNAL OF EVIDENCE-BASED MEDICINE
2009年
5期
309-313
,共5页
妊娠相关血浆蛋白-A%急性冠脉综合征%诊断价值%特异度%敏感度
妊娠相關血漿蛋白-A%急性冠脈綜閤徵%診斷價值%特異度%敏感度
임신상관혈장단백-A%급성관맥종합정%진단개치%특이도%민감도
pregnancy-associated plasma protein-A%acute coronary syndrome%diagnostic value%sensitivity%specificity
目的 通过对不同血清标记物组合早期诊断急性冠脉综合征的价值进行比较,探讨妊娠相关血浆蛋白-A(PAPP-A)在提高组合诊断效能方面的作用.方法 检测急性冠脉综合征患者、急性冠脉综合征疑似患者PAPP-A、超敏C反应蛋白(hs-CRP)和肌钙蛋白I(cTnI)水平.绘制3种标记物用于诊断急性冠脉综合征的受试者特征曲线(ROC曲线),冉根据ROC曲线确定三者诊断急性冠脉综合征的诊断阈值,并对确立的标记物组合"PAPP-A+cTnI"、"cTnI+hs-CRP"和"PAPP-A+cTnI+hs-CRP"的诊断准确度进行比较.结果 三种标记物诊断急性冠脉综合征的ROC曲线下面积分别为:PAPP-A 0.978(95%CI 0.956～1.000),cTnI 0.873(95%CI 0.797～0.948),hs-CRP 0.841(95%CI 0.761～0.920);依此确定的三种标记物用于诊断急性冠脉综合征的诊断阈值为:PAPP-A 17.225μg/mL,hs-CRP 6.215 mg/L,cTnI 1.030 ng/mL.PAPP-A、hs-CRP、cTnI、"PAPP-A+cTnI"、"cTnI+hs-CRP"和"PAPP-A+cTnI+hs-CRP"的敏感度依次为0.889、0.733、0.689、0.956、0.956和0.956;特异度为0.956、0.778、1.000、0.956、0.778和0.756;诊断正确率为0.922、0.778、0.833、0.956、0.878和0.856."PAPP-A+cTnI"较之于单独的标记物及其它组合,具有较高的诊断正确率(0.956)、较高的诊断特异度(0.956)、诊断敏感度(0.956)和阳性预测值(0.956).结论 组合"PAPP-A+cTnI"对急性冠脉综合征的综合诊断价值较高,对于急性冠脉综合征的早期诊断具有更高的诊断价值.
目的 通過對不同血清標記物組閤早期診斷急性冠脈綜閤徵的價值進行比較,探討妊娠相關血漿蛋白-A(PAPP-A)在提高組閤診斷效能方麵的作用.方法 檢測急性冠脈綜閤徵患者、急性冠脈綜閤徵疑似患者PAPP-A、超敏C反應蛋白(hs-CRP)和肌鈣蛋白I(cTnI)水平.繪製3種標記物用于診斷急性冠脈綜閤徵的受試者特徵麯線(ROC麯線),冉根據ROC麯線確定三者診斷急性冠脈綜閤徵的診斷閾值,併對確立的標記物組閤"PAPP-A+cTnI"、"cTnI+hs-CRP"和"PAPP-A+cTnI+hs-CRP"的診斷準確度進行比較.結果 三種標記物診斷急性冠脈綜閤徵的ROC麯線下麵積分彆為:PAPP-A 0.978(95%CI 0.956～1.000),cTnI 0.873(95%CI 0.797～0.948),hs-CRP 0.841(95%CI 0.761～0.920);依此確定的三種標記物用于診斷急性冠脈綜閤徵的診斷閾值為:PAPP-A 17.225μg/mL,hs-CRP 6.215 mg/L,cTnI 1.030 ng/mL.PAPP-A、hs-CRP、cTnI、"PAPP-A+cTnI"、"cTnI+hs-CRP"和"PAPP-A+cTnI+hs-CRP"的敏感度依次為0.889、0.733、0.689、0.956、0.956和0.956;特異度為0.956、0.778、1.000、0.956、0.778和0.756;診斷正確率為0.922、0.778、0.833、0.956、0.878和0.856."PAPP-A+cTnI"較之于單獨的標記物及其它組閤,具有較高的診斷正確率(0.956)、較高的診斷特異度(0.956)、診斷敏感度(0.956)和暘性預測值(0.956).結論 組閤"PAPP-A+cTnI"對急性冠脈綜閤徵的綜閤診斷價值較高,對于急性冠脈綜閤徵的早期診斷具有更高的診斷價值.
목적 통과대불동혈청표기물조합조기진단급성관맥종합정적개치진행비교,탐토임신상관혈장단백-A(PAPP-A)재제고조합진단효능방면적작용.방법 검측급성관맥종합정환자、급성관맥종합정의사환자PAPP-A、초민C반응단백(hs-CRP)화기개단백I(cTnI)수평.회제3충표기물용우진단급성관맥종합정적수시자특정곡선(ROC곡선),염근거ROC곡선학정삼자진단급성관맥종합정적진단역치,병대학립적표기물조합"PAPP-A+cTnI"、"cTnI+hs-CRP"화"PAPP-A+cTnI+hs-CRP"적진단준학도진행비교.결과 삼충표기물진단급성관맥종합정적ROC곡선하면적분별위:PAPP-A 0.978(95%CI 0.956～1.000),cTnI 0.873(95%CI 0.797～0.948),hs-CRP 0.841(95%CI 0.761～0.920);의차학정적삼충표기물용우진단급성관맥종합정적진단역치위:PAPP-A 17.225μg/mL,hs-CRP 6.215 mg/L,cTnI 1.030 ng/mL.PAPP-A、hs-CRP、cTnI、"PAPP-A+cTnI"、"cTnI+hs-CRP"화"PAPP-A+cTnI+hs-CRP"적민감도의차위0.889、0.733、0.689、0.956、0.956화0.956;특이도위0.956、0.778、1.000、0.956、0.778화0.756;진단정학솔위0.922、0.778、0.833、0.956、0.878화0.856."PAPP-A+cTnI"교지우단독적표기물급기타조합,구유교고적진단정학솔(0.956)、교고적진단특이도(0.956)、진단민감도(0.956)화양성예측치(0.956).결론 조합"PAPP-A+cTnI"대급성관맥종합정적종합진단개치교고,대우급성관맥종합정적조기진단구유경고적진단개치.
Objective To compare the different combination of biochemical markers in early diagnosis of acute coronary syndrome (ACS). Methods Serum PAPP-A, hs-CRP and cTnI concentrations were measured in 45 ACS patients and 45 suspected patients.ROC curves of three markers established respectively, and the cut off values were determined accordingly. Diagnostic accuracy of the markers was calculated and compared. The diagnostic accuracy (Se, Sp, diagnostic accuracy rate) of the three combinations("PAPP-A +cTnI", "hs-CRP+cTnI" and "PAPP-A+hs-CRP+cTnI") and the three markers themselves were calculated and compared. Results Compared with the suspected patients,the AUCs of the three markers were: PAPP-A 0.978 (95%CI 0.956 to 1.000), hs-CRP 0.841 (95%CI 0.761 to 0.920), cTnI 0.873 (95%CI 0.797 to 0.948). Respectively cut off values of the three markers for diagnosing ACS were defined as PAPP-A17.225 μg/mL, hs-CRP 6.215 mg/L and cTnI 1.030 ng/mL. The diagnostic accuracy of these markers and their combinations (PAPP-A, hs-CRP, cTnI, "PAPP-A+cTnI", "cTnI+hs-CRP" and "PAPP-A+cTnI+hs-CRP") were calculated and presented as follows: sensitivity : 0.889,0.733,0.689,0.956,0.956,0.956; specificity: 0.956,0.778,1.000,0.956,0.778,0.756; diagnostic efficacy: 0.922,0.778,0.833,0.956,0.878,0.856.Compared with the other markers and combinations, the combination of "PAPP-A + cTnI" had higher sensitivity, specificity and diagnostic accurancy. Conclusions The combination of "PAPP-A + cTnI" can improve the sensitivity and specificity of the early diagnosing ACS.
