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|本期目录/Table of Contents|

临床检验指标联合心电图对冠心病的诊断价值

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第5期
页码:
603-605,612
栏目:
临床研究
出版日期:
2015-05-05

文章信息/Info

Title:
Value of combining electrocardiogram and clinical examination indexes to diagnose coronary heart disease
作者:
聂 晨; 丁进叶; 方 冬; 龚 斐; 干学东; 任江华
（武汉大学中南医院心内科,湖北 武汉 430071）
Author(s):
NIE Chen;  DING Jin-ye;  FANG Dong;  GONG Fei;  GAN Xue-dong;  REN Jiang-hua
(Department of Cardiology, Zhongnan Hospital, Wuhan University, Wuhan 430071, Hubei, China)
关键词:
冠状动脉疾病; 冠脉造影术; 超敏C反应蛋白; ROC曲线; 心电图; 载脂蛋白A1
Keywords:
coronary disease;  angiography;  hs-CRP;  ROC curve;  ECG;  ApoA1
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 探讨心电图、超敏C反应蛋白（hs-CRP）及载脂蛋白(Apo)A1联合诊断冠心病的价值。方法 收集2010~2011年有可疑冠心病症状在我院行冠脉造影术的患者818例，其中冠脉造影提示冠心病565例（冠心病组），冠脉造影未达冠心病标准253例（非冠心病组），收集患者的临床指标心电图（ECG）、hs-CRP,ApoA1,低密度脂蛋白胆固醇（LDL-C）及一般资料（年龄、性别、高血压病、糖尿病、高脂血症和吸烟等）。采用SPSS18.0统计软件进行单因素相关分析，对有显著相关的指标进行受试者工作特征曲线（ROC曲线），寻找截断点，并进行分类划线统计分析，计算各指标及联合诊断的敏感度及特异度。结果 与非冠心病组相比，冠心病组hs-CRP明显升高，ApoA1明显降低（P<0.01）,ECG多出现ST-T改变（P<0.01）。绘制受试者工作特征曲线得出hs-CRP及ApoA1的截断点值分别为1.155 mg/L和1.055 g/L，采用四格表法计算其敏感度（Se）分别为73.8%和43.5%，特异度（Sp）分别为51.4%和77.1%，心电图ST-T改变对冠心病诊断的Se为77.3%，Sp为20.9%；系列联合诊断：ECG+ApoA1(Se:35.8%,Sp:85.4%)、ECG+hs-CRP(Se:58.5%，Sp:71.5%)、hs-CRP+ApoA1(Se 34.9%，Sp 87.7%)、ECG+ApoA1+hs-CRP(Se 28.7%，Sp 92.1%)。平行联合诊断ECG+hs-CRP(Se 92.7%，Sp 72.7%)、ApoA1+ECG(Se 85.1%，Sp 39.1%)、ApoA1+hs-CRP(Se 82.7%，Sp 40.9%),ECG+ApoA1+hs-CRP(Se 94.3%,Sp 23.3%)。结论 联合ECG、ApoA1和hs-CRP可提高诊断冠心病的灵敏度或特异度.
Abstract:
AIM To investigate the sensitivity and specificity of combining electrocardiogram, high-sensitivity C-reactive protein and apolipoprotein A-1 to diagnose coronary heart disease. METHODS In this case-control study, 818 individuals with suspicion of CAD underwent coronary angiography in Zhongnan Hospital during 2010 to 2011. Based on the results of angiography, 565 subjects were diagnosed as coronary heart disease (CHD) and classified into experimental group, whereas 253 were normal and classified as control group. Meanwhile, low-density lipoprotein cholesterol (LDL-C), hs-CRP (high-sensitivity C-reactive protein), ApoA1 (apolipoprotein A1) and ECG (electrocardiogram) were analyzed. Data were entered into the SPSS v.18.0 statistical software for analysis. For those indicators that have significant correlation with CHD, receiver operating characteristic curve analysis was carried out looking for the cut-off point and crossed statistical analysis was classified to calculate the index and joint index diagnostic sensitivity and specificity. RESULTS Compared with the control group, plasma hs-CRP level is significantly higher, whereas ApoA1 is lower in the experimental group. ECG with ST-T change is common in the experimental group. The sensitivity of hs-CRP, ApoA1, and ECG is 73.8%, 43.5%, 77.3%, respectively. Specificity is 51.4%, 77.1%, 20.9%, respectively. Series of joint diagnosis: sensitivity of ECG+ApoA1, ECG+hs-CRP, hs-CRP+ApoA1 and ECG+ApoA1+hs CRP is 35.8%, 58.5%, 34.9%, 28.7%, respectively, and the specificity is 85.4%, 71.5%, 87.7%, 92.1%, respectively. Parallel to the joint diagnosis: sensitivity of ECG+hs-CRP, ApoA1+ECG, ApoA1+hs-CRP and ECG+ApoA1+hs-CRP is 92.7%, 85.1%, 82.7% and 94.3%, respectively. Specificity is 72.7%, 39.1%, 40.9% and 23.3%, respectively. CONCLUSION The combination of ECG, hs-CRP and ApoA1 can improve the sensitivity or specificity of early clinical diagnosis of CHD.

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备注/Memo

备注/Memo:
收稿日期：2014-10-17.
通讯作者：任江华,主任医师，主要从事冠心病防治研究 Email：renjh321@aliyun.com
作者简介：聂晨,硕士生 Email：nc3625@sina.com
更新日期/Last Update: 2015-04-28