基于hs-CRP、HMGB1及Myo的急性冠脉综合征诊断预测模型构建
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摘要
目的探讨急性冠脉综合征(acute coronary syndromes,ACS)患者不同心肌标志物水平变化以及联合多种心肌志记物对ACS的预测作用。方法选取ACS患者100例,对照组89例,分别检测血清中血脂常规生化指标;心肌损伤标志物包括肌酸激酶同工酶(Creatine kinase isoenzyme,CK-MB)、肌钙蛋白T(troponin T,TnT)、肌红蛋白(myoglobin,Myo)、超敏肌钙蛋白T(hypersensitive troponin,hs-TnT)、脑钠肽(brain natriuretic peptide,BNP);炎症因子包括高迁移率族蛋白1(high mobility group box-1 protein,HMGB1)、超敏C-反应蛋白(high sensitive C-reactive protein,hs-CRP);白细胞(white blood cell,WBC);中性粒细胞百分比以及空腹血糖水平,并比较两组之间的差异。结果 ACS组患者血清中BNP、CK-MB、TnT、Myo、hs-CRP、hs-TnT、以及HMGB1水平均高于对照组(P<0. 05); hsCRP、HMGB1联合Myo构建模型对ACS测试集数据进行诊断预测,阴性预测率为81. 82%,阳性预测率为95. 24%,AUC为0. 906 3; hs-CRP、HMGB1与CK-MB为ACS发生的危险因素,OR分别为1. 95(95%CI:1. 32～2. 55)、7. 44(95%CI:6. 51～8. 14)与3. 51(95%CI:2. 33～4. 59); Myo为ACS发生的保护因素,OR为0. 17(95%CI:0. 10～0. 35)。结论血清hs-CRP、HMGB1与Myo构建预测模型有助于对ACS患者的早期诊断。
Objective To establish a predictive model for acute coronary syndrome( ACS) based on Hs-CRP,HMGB1 and Myo. Methods One hundred ACS patients( ACS group) and 89 healthy subjects( control group) were enrolled in the study. Blood lipids( TC,TG,HDL and LDL),myocardial injury markers( CK-MB, TnT, Myo, hs-TnT and BNP), inflammatory factors( HMGB1 and hs-CRP),polymorphic particles and fasting blood glucose levels were measured and compared between two groups.Logistic regression was used to establish a predictive model for ACS. Results The CK-MB,TnT,Myo,hs-TnT,HMGB1,BNP and hs-CRP levels in ACS group were significantly higher than those in control group( P < 0. 05). Logistic regression analysis showed that hs-CRP,HMGB1 and CK-MB were the risk factors for ACS( OR = 1. 95,95% CI: 1. 32-2.55; OR = 7. 44,95% CI: 6. 51-8. 14; OR = 3. 51,95% CI:2. 33-4. 59),and Myo was the protective factor of ACS( OR = 0. 17,95%CI: 0. 10-0. 35). A predictive model was established based on hs-CRP,HMGB1 and Myo. The area under curve( AUC) of the model was 0. 906 3,and the positive predictive value and the negative predictive value were 95. 24% and81. 82%,respectively. Conclusion Serum hs-CRP,HMGB1 and Myo are of value in early diagnosis of patients with acute coronary syndrome.
Objective To establish a predictive model for acute coronary syndrome( ACS) based on Hs-CRP,HMGB1 and Myo. Methods One hundred ACS patients( ACS group) and 89 healthy subjects( control group) were enrolled in the study. Blood lipids( TC,TG,HDL and LDL),myocardial injury markers( CK-MB, TnT, Myo, hs-TnT and BNP), inflammatory factors( HMGB1 and hs-CRP),polymorphic particles and fasting blood glucose levels were measured and compared between two groups.Logistic regression was used to establish a predictive model for ACS. Results The CK-MB,TnT,Myo,hs-TnT,HMGB1,BNP and hs-CRP levels in ACS group were significantly higher than those in control group( P < 0. 05). Logistic regression analysis showed that hs-CRP,HMGB1 and CK-MB were the risk factors for ACS( OR = 1. 95,95% CI: 1. 32-2.55; OR = 7. 44,95% CI: 6. 51-8. 14; OR = 3. 51,95% CI:2. 33-4. 59),and Myo was the protective factor of ACS( OR = 0. 17,95%CI: 0. 10-0. 35). A predictive model was established based on hs-CRP,HMGB1 and Myo. The area under curve( AUC) of the model was 0. 906 3,and the positive predictive value and the negative predictive value were 95. 24% and81. 82%,respectively. Conclusion Serum hs-CRP,HMGB1 and Myo are of value in early diagnosis of patients with acute coronary syndrome.
引文
[1]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304.
[2]DIMOVA R,TANKOVA T,CHAKAROVA N,et al.Cardiovascular autonomic tone relation to metabolic parameters and hs CRP in normoglycemia and prediabetes[J].Diabetes Res Clin Pract,2015,109(2):262-270.
[3]徐清芳,张美华,韩晨鹏,等.血清肌红蛋白、心肌肌钙蛋白Ⅰ联合超敏C反应蛋白对老年急性心肌梗死诊断的临床价值[J].中国老年学,2012,32(5):948-949.
[4]XU Q,BO L,HU J,et al.High mobility group box 1was associated with thrombosis in patients with atrial fibrillation[J].Medicine(Baltimore),2018,97(13):e0132.
[5]刘敏,杨俊,李莉,等.冠心病患者高迁移率族蛋白1的表达与意义[J].中国老年学杂志,2011,31(7):1104-1105.
[6]HU X,JIANG H,BAI Q,et al.Increased serum HMGB1 is related to the severity of coronary artery stenosis[J].Clin Chim Acta,2009,406(1):139-142.
[7]杨萍,陆林,朱天奇,等.急性ST段抬高型心梗患者血清HMGB1检测及其临床意义[J].国际心血管病杂志,2012,39(4):239-241.
[8]S?RENSEN M V,PEDERSEN S,M?GELVANG R,et al.Plasma high-mobility group box 1 levels predict mortality after ST-segment elevation myocardial infarction[J].JACC Cardiovasc Interv,2011,4(3):281-286.
[9]HASHIMOTO T,ISHII J,KITAGAWA F,et al.Circulating high-mobility group box 1 and cardiovascular mortality in unstable angina and non-ST-segment elevation myocardial infarction[J].Atherosclerosis,2012,221(2):490-495.
[10]LEE H Y,CHOI J S,GURUPRASATH P,et al.An electrochemical biosensor based on a myoglobin-specific binding peptide for early diagnosis of acute myocardial infarction[J].Anal Sci,2015,31(7):699-704.
[11]何水生,曾艳.肌红蛋白、肌酸激酶同工酶和心肌肌钙蛋白联合检测在急性心肌梗死早期诊断的临床意义[J].中国实用医刊,2012,39(1):34-35.
[12]李继红,邹佳.肌钙蛋白Ⅰ、肌红蛋白、肌酸激酶同工酶在急性心肌梗死诊断中的应用[J].武警医学,2012,23(7):638-638.
[13]KAVSAK P A,MACRAE A R,NEWMAN A M,et al.Effects of contemporary troponin assay sensitivity on the utility of the early markers myoglobin and CKMB isoforms in evaluating patients with possible acute myocardial infarction[J].Clin Chim Acta,2007,380(1-2):213-216.
[14]MACNAMARA J,EAPEN D J,QUYYUMI A,et al.Novel biomarkers for cardiovascular risk assessment:current status and future directions[J].Future Cardiol,2015,11(5):597-613.
[15]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[16]姚云婕.急性冠脉综合征患者高迁移率族蛋白B1和超敏C反应蛋白的变化及意义[J].中国分子心脏病学杂志,2014,14(6):1130-1134.
[17]李娇,李新明,柳亮,等.血清HMGB1和hs-CRP水平与冠心病严重程度的相关性分析[J].中国动脉硬化杂志,2015,23(2):175-179.
[18]曾瑞翔,张冰雨,雷涛.硫辛酸对2型糖尿病患者SOD、MDA及hs-CRP水平的影响[J].同济大学学报(医学版),2016,37(2):40-43.
[19]高岚,郭爱叶,张培荣,等.联合检测心肌损伤标志物在老年急性冠脉综合征患者发病早期中的应用价值[J].中国老年学杂志,2015,35(16):4538-4539.
[2]DIMOVA R,TANKOVA T,CHAKAROVA N,et al.Cardiovascular autonomic tone relation to metabolic parameters and hs CRP in normoglycemia and prediabetes[J].Diabetes Res Clin Pract,2015,109(2):262-270.
[3]徐清芳,张美华,韩晨鹏,等.血清肌红蛋白、心肌肌钙蛋白Ⅰ联合超敏C反应蛋白对老年急性心肌梗死诊断的临床价值[J].中国老年学,2012,32(5):948-949.
[4]XU Q,BO L,HU J,et al.High mobility group box 1was associated with thrombosis in patients with atrial fibrillation[J].Medicine(Baltimore),2018,97(13):e0132.
[5]刘敏,杨俊,李莉,等.冠心病患者高迁移率族蛋白1的表达与意义[J].中国老年学杂志,2011,31(7):1104-1105.
[6]HU X,JIANG H,BAI Q,et al.Increased serum HMGB1 is related to the severity of coronary artery stenosis[J].Clin Chim Acta,2009,406(1):139-142.
[7]杨萍,陆林,朱天奇,等.急性ST段抬高型心梗患者血清HMGB1检测及其临床意义[J].国际心血管病杂志,2012,39(4):239-241.
[8]S?RENSEN M V,PEDERSEN S,M?GELVANG R,et al.Plasma high-mobility group box 1 levels predict mortality after ST-segment elevation myocardial infarction[J].JACC Cardiovasc Interv,2011,4(3):281-286.
[9]HASHIMOTO T,ISHII J,KITAGAWA F,et al.Circulating high-mobility group box 1 and cardiovascular mortality in unstable angina and non-ST-segment elevation myocardial infarction[J].Atherosclerosis,2012,221(2):490-495.
[10]LEE H Y,CHOI J S,GURUPRASATH P,et al.An electrochemical biosensor based on a myoglobin-specific binding peptide for early diagnosis of acute myocardial infarction[J].Anal Sci,2015,31(7):699-704.
[11]何水生,曾艳.肌红蛋白、肌酸激酶同工酶和心肌肌钙蛋白联合检测在急性心肌梗死早期诊断的临床意义[J].中国实用医刊,2012,39(1):34-35.
[12]李继红,邹佳.肌钙蛋白Ⅰ、肌红蛋白、肌酸激酶同工酶在急性心肌梗死诊断中的应用[J].武警医学,2012,23(7):638-638.
[13]KAVSAK P A,MACRAE A R,NEWMAN A M,et al.Effects of contemporary troponin assay sensitivity on the utility of the early markers myoglobin and CKMB isoforms in evaluating patients with possible acute myocardial infarction[J].Clin Chim Acta,2007,380(1-2):213-216.
[14]MACNAMARA J,EAPEN D J,QUYYUMI A,et al.Novel biomarkers for cardiovascular risk assessment:current status and future directions[J].Future Cardiol,2015,11(5):597-613.
[15]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[16]姚云婕.急性冠脉综合征患者高迁移率族蛋白B1和超敏C反应蛋白的变化及意义[J].中国分子心脏病学杂志,2014,14(6):1130-1134.
[17]李娇,李新明,柳亮,等.血清HMGB1和hs-CRP水平与冠心病严重程度的相关性分析[J].中国动脉硬化杂志,2015,23(2):175-179.
[18]曾瑞翔,张冰雨,雷涛.硫辛酸对2型糖尿病患者SOD、MDA及hs-CRP水平的影响[J].同济大学学报(医学版),2016,37(2):40-43.
[19]高岚,郭爱叶,张培荣,等.联合检测心肌损伤标志物在老年急性冠脉综合征患者发病早期中的应用价值[J].中国老年学杂志,2015,35(16):4538-4539.
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