血清缺血修饰白蛋白和同型半胱氨酸与冠状动脉粥样硬化性心脏病的相关性及联合检测对疾病的临床诊断价值
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摘要
目的研究血清缺血修饰白蛋白(IMA)和同型半胱氨酸(Hcy)与冠状动脉粥样硬化性心脏病(冠心病)的相关性,并分析两项指标联合检测对冠心病临床诊断价值。方法选取河北省衡水市人民医院2015年3月至2018年7月收诊的126例冠心病患者作为观察组,其中ST段抬高型急性冠状动脉综合征(STEACS) 28例,非ST段抬高型急性心肌梗死(NSTEMI) 32例,不稳定型心绞痛(UAP) 30例,稳定型心绞痛(SAP) 36例;单支病变33例,双支病变48例,多支病变45例;另选取同期体检者120名作为对照组,检测血清IMA、Hcy水平。分析血清IMA、Hcy水平与冠心病类型、冠状动脉病变程度的相关性,比较血清IMA、Hcy联合及单独检测的诊断价值。结果 UAP、NSTEMI、STEACS患者血清IMA、Hcy水平明显高于SAP患者和体检者[(87±12)、(110±11)、(122±13) k U/L比(70±10)、(68±10) k U/L,(15. 7±2. 5)、(21. 7±3. 1)、(26. 6±3. 5)μmol/L比(10. 0±1. 2)、(9. 4±1. 0)μmol/L],差异均有统计学意义(均P <0. 05)。多支病变者血清IMA、Hcy水平较双支、单支病变者高[(92±6) k U/L比(86±5)、(80±5) k U/L,(16. 3±1. 2)μmol/L比(11. 8±1. 6)、(10. 5±1. 3)μmol/L],且双支病变者高于单支病变者,差异均有统计学意义(均P <0. 05)。Spearman相关性分析结果显示,血清IMA水平与冠心病类型(病情由轻到重)(r=0. 803,P <0. 001)、冠状动脉病变支数(r=0. 512,P=0. 008)均呈正相关;血清Hcy水平与冠心病类型(病情由轻到重)(r=0. 745,P <0. 001)、冠状动脉病变支数(r=0. 486,P=0. 013)均呈正相关。血清IMA联合Hcy检测的诊断敏感度较IMA和Hcy单独检测(96. 03%比81. 75%、76. 19%)高,诊断准确率亦较单独检测(84. 96%比77. 64%、75. 61%)高,差异均有统计学意义(均P <0. 05),而诊断特异度与二者单独检测比较差异无统计学意义(P> 0. 05)。结论血清IMA、Hcy水平在CHD患者中呈现异常高表达状态,与冠心病类型(病情由轻到重)、冠状动脉病变支数具有正相关关系,二者联合检测可在不影响诊断特异度基础上提高诊断准确率、敏感度,为临床准确判断冠心病类型、病情程度、制定合理治疗方案及评估预后情况提供有力信息支持。
Objective To investigate the correlation among serum ischemic modified albumin( IMA),homocysteine( Hcy) and coronary atherosclerotic heart disease( CHD) and the diagnostic value of combined detection of IMA and Hcy for CHD. Methods From March 2015 to July 2018,126 CHD patients including 28 cases of ST-segment elevation acute coronary syndrome( STEACS),32 cases of non-ST-segment elevation acute myocardial infarction( NSTEMI),30 cases of unstable angina pectoris( UAP),36 cases of stable angina pectoris( SAP),33 cases of single-vessel disease,48 cases of dual-vessel disease,45 cases of multi-vessel disease,and120 healthy people were enrolled in People's Hospital of Hengshui. Serum levels of IMA and Hcy were measured.Correlations of IMA and Hcy with the type and severity of CHD were analyzed. Diagnostic values of combined and separate detection of IMA and Hcy were analyzed. Results Levels of serum IMA and Hcy in patients with UAP,NSTEMI and STEACS were significantly higher than those in SAP and healthy subjects[( 87 ± 12),( 110 ± 11),( 122 ± 13) k U/L vs( 70 ± 10),( 68 ± 10) k U/L;( 15. 7 ± 2. 5)( 21. 7 ± 3. 1),( 26. 6 ± 3. 5) μmol/L vs( 10. 0 ± 1. 2),( 9. 4 ± 1. 0) μmol/L]( all P < 0. 05). Levels of serum IMA and Hcy increased among patients with single-vessel disease,dual-vessel and multi-vessel disease[( 80 ± 5) k U/L vs( 86 ± 5),( 92 ± 6) k U/L;( 10. 5 ±1. 3) μmol/L vs( 11. 8 ± 1. 6),( 16. 3 ± 1. 2) μmol/L]( all P < 0. 05). Spearman analysis showed that serum IMA level was positively correlated with the type( from mild to severe) and severity( number of lesions) of CHD( r = 0. 803,P < 0. 001; r = 0. 512,P = 0. 008); serum Hcy level was positively correlated with the type and severity of CHD( r = 0. 745,P < 0. 001; r = 0. 486,P = 0. 013). Combined detection of IMA and Hcy showed higher diagnostic specificity and accuracy than IMA to Hcy separate detection( 96. 03% vs 81. 75%,76. 19%;84. 96% vs 77. 64%,75. 61%)( all P < 0. 05) but there was no significant difference of diagnostic specificity among them( P > 0. 05). Conclusions CHD patients have abnormally elevated levels of serum IMA and Hcy,which are positively correlated with the type and severity of disease. Combined detection of IMA and Hcy can improve the diagnostic accuracy and sensitivity without affecting the specificity,providing powerful reference for clinical identification,illness evaluation,reasonable therapeutic choice and prognostic prediction of CHD.
Objective To investigate the correlation among serum ischemic modified albumin( IMA),homocysteine( Hcy) and coronary atherosclerotic heart disease( CHD) and the diagnostic value of combined detection of IMA and Hcy for CHD. Methods From March 2015 to July 2018,126 CHD patients including 28 cases of ST-segment elevation acute coronary syndrome( STEACS),32 cases of non-ST-segment elevation acute myocardial infarction( NSTEMI),30 cases of unstable angina pectoris( UAP),36 cases of stable angina pectoris( SAP),33 cases of single-vessel disease,48 cases of dual-vessel disease,45 cases of multi-vessel disease,and120 healthy people were enrolled in People's Hospital of Hengshui. Serum levels of IMA and Hcy were measured.Correlations of IMA and Hcy with the type and severity of CHD were analyzed. Diagnostic values of combined and separate detection of IMA and Hcy were analyzed. Results Levels of serum IMA and Hcy in patients with UAP,NSTEMI and STEACS were significantly higher than those in SAP and healthy subjects[( 87 ± 12),( 110 ± 11),( 122 ± 13) k U/L vs( 70 ± 10),( 68 ± 10) k U/L;( 15. 7 ± 2. 5)( 21. 7 ± 3. 1),( 26. 6 ± 3. 5) μmol/L vs( 10. 0 ± 1. 2),( 9. 4 ± 1. 0) μmol/L]( all P < 0. 05). Levels of serum IMA and Hcy increased among patients with single-vessel disease,dual-vessel and multi-vessel disease[( 80 ± 5) k U/L vs( 86 ± 5),( 92 ± 6) k U/L;( 10. 5 ±1. 3) μmol/L vs( 11. 8 ± 1. 6),( 16. 3 ± 1. 2) μmol/L]( all P < 0. 05). Spearman analysis showed that serum IMA level was positively correlated with the type( from mild to severe) and severity( number of lesions) of CHD( r = 0. 803,P < 0. 001; r = 0. 512,P = 0. 008); serum Hcy level was positively correlated with the type and severity of CHD( r = 0. 745,P < 0. 001; r = 0. 486,P = 0. 013). Combined detection of IMA and Hcy showed higher diagnostic specificity and accuracy than IMA to Hcy separate detection( 96. 03% vs 81. 75%,76. 19%;84. 96% vs 77. 64%,75. 61%)( all P < 0. 05) but there was no significant difference of diagnostic specificity among them( P > 0. 05). Conclusions CHD patients have abnormally elevated levels of serum IMA and Hcy,which are positively correlated with the type and severity of disease. Combined detection of IMA and Hcy can improve the diagnostic accuracy and sensitivity without affecting the specificity,providing powerful reference for clinical identification,illness evaluation,reasonable therapeutic choice and prognostic prediction of CHD.
引文
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[2]刘晖,姚亚利.心脏远程监护技术、超声心动图及动态心电图诊断心肌缺血的准确性比较[J].中国临床医生杂志,2017,45(11):41-44. DOI:10. 3969/j. issn. 2095-8552. 2017. 11. 015.Liu H,Yao YL. Accuracy comparison of cardiac remote monitoring technology,echocardiography and dynamic electrocardiogram in diagnosis of myocardial ischemia[J]. Chinese Journal for Clinicians,2017,45(11):41-44. DOI:10. 3969/j. issn. 2095-8552.2017. 11. 015.
[3]Kaptoge S,Seshasai SR,Gao P,et al. Inflammatory cytokines and risk of coronary heart disease:new prospective study and updated meta-analysis[J]. Eur Heart J,2014,35(9):578-589.DOI:10. 1093/eurheartj/eht367.
[4]付伟光,齐振勇,李爱军,等. HCY、HS-CRP、LP(a)及D-二聚体联合检测在冠心病病程中动态检测意义的研究[J].西部中医药,2014,27(8):148-151. DOI:10. 3969/j. issn. 1004-6852.2014. 08. 066.Fu WG,Qi ZY,Li AJ,et al. Research on the meaning of dynamic detection of HCY,HS-CRP,Lp(a)and D-dimer in the duration of coronary heart disease[J]. Western Journal of Traditional Chinese Medicine,2014,27(8):148-151. DOI:10. 3969/j.issn. 1004-6852. 2014. 08. 066.
[5]叶雄伟,于小妹,冯越,等.血清缺血修饰白蛋白在心肌缺血早期诊断中的意义及与冠脉造影结果相关性分析[J].中国卫生检验杂志,2014,24(24):3511-3514.Ye XW,Yu XM,Feng Y,et al. Research on the value of serum IMA in the diagnosis of early ischemia myocardial and the correlation with coronary angiography results[J]. Chinese Journal of Health Laboratory Technology,2014,24(24):3511-3514.
[6]胡大一.心血管疾病防治中国专家共识[M].北京:人民卫生出版社,2006:156-166.Hu DY. Consensus of Chinese experts on the prevention and treatment of cardiovascular diseases[M]. Beijing:People's Health Publishing House,2006:156-166.
[7]常莹,秦俭,李思颉.缺血修饰白蛋白在心血管领域中的研究进展[J].中国医药,2011,6(11):1427-1429. DOI:10. 3760/cma. j. issn. 1673-4777. 2011. 11. 062.Chang Y,Qin J,Li SJ. Research progress of ischemia-modified albumin in cardiovascular field[J]. China Medicine,2011,6(11):1427-1429. DOI:10. 3760/cma. j. issn. 1673-4777. 2011. 11. 062.
[8]赵伟,李婷婷,李莹.冠心病患者炎性因子水平与急性冠状动脉综合征的相关性分析[J].中华老年心脑血管病杂志,2014,16(2):207-208. DOI:10. 3969/j. issn. 1009-0126. 2014.02. 025.Zhao W,Li TT,Li Y. Correlation between inflammatory factors and acute coronary syndrome in patients with coronary heart disease[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases,2014,16(2):207-208. DOI:10. 3969/j. issn. 1009-0126. 2014. 02. 025.
[9]Andersson C,Shilane D,Go AS,et al.β-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease[J]. J Am Coll Cardiol,2014,64(3):247-252. DOI:10. 1016/j. jacc. 2014. 04. 042.
[10]陈曦,邓蔷,安娜,等.血清Fractalkine、Vaspin含量对冠心病病情的判断价值及其与心功能、心肌损伤程度的相关关系[J].海南医学院学报,2017,23(19):2612-2615.Chen X,Deng Q,An N,et al. The value of serum Fractalkine and Vaspin contents for the diagnosis of coronary heart dis-ease and their correlation with cardiac function and myocardial injury[J].Journal of Hainan Medical University,2017,23(19):2612-2615.
[11]宋现涛,吕树铮.缺血修饰性白蛋白在冠心病心肌缺血诊断中应用价值的循证评价[J].中国循证心血管医学杂志,2008,1(1):49-52. DOI:10. 3969/j. issn. 1674-4055. 2008. 01. 019.Song XT,Lyu SZ. The value of ischemia modified albumin in the diagnosis of myocardial ischemia in coronary heart disease[J].Chinese Journal of Evidence-Bases Cardiovascular Medicine,2008,1(1):49-52. DOI:10. 3969/j. issn. 1674-4055. 2008.01. 019.
[12]肖建东,张俊岭,路玉李,等.超声检测心外膜脂肪组织联合缺血修饰白蛋白在冠心病诊断中的应用价值[J].中国循证心血管医学杂志,2017,9(6):687-689. DOI:10. 3969/j. issn. 1674-4055. 2017. 06. 12.Xiao JD,Zhang JL,Lu YL,et al. Application value of ultrasonic detection of epicardial adipose tissue combined with ischemia modified albumin in diagnosis of coronary heart disease[J].Chinese Journal of Evidence-Bases Cardiovascular Medicine,2017,9(6):687-689. DOI:10. 3969/j. issn. 1674-4055. 2017. 06. 12.
[13]Sertoglu E,Kayadibi H,Uyanik M. Biochemical view on"Homocysteine and metabolic syndrome:From clustering to additional utility in prediction of coronary heart disease"[J]. J Cardiol,2015,65(5):439. DOI:10. 1016/j. jjcc. 2014. 11. 010.
[14]齐宏,黄珊,马祥生,等.同型半胱氨酸、高敏C反应蛋白及胱抑素C和脂蛋白相关磷脂酶A_2与冠心病的相关性[J].广东医学,2014,35(14):2253-2256. DOI:10. 3969/j. issn. 1001-9448. 2014. 14. 044.Qi H,Huang S,Ma XS,et al. Correlation among homocysteine,high sensitive C-reactive protein,cystatin C,lipoprotein-associated phospholipase A2 and coronary heart disease[J]. Guangdong Medical Journal,2014,35(14):2253-2256. DOI:10. 3969/j.issn. 1001-9448. 2014. 14. 044.
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