高敏C反应蛋白、心肌肌钙蛋白I、B型钠尿肽水平对急性心血管病的诊断价值

摘要

目的:探讨高敏C反应蛋白(hsCRP)、心肌肌钙蛋白I(cTnI)、B型钠尿肽(BNP)水平对急性心血管病(ACVD)的诊断价值.方法:选择我院收治的ACVD患者216例(ACVD组)和同期进行健康体检的正常人216例(健康对照组)为研究对象.ACVD组又根据治疗后是否发生主要不良心血管事件(MACE)分为MACE组(52例)和无MACE组(164例);检测并比较各组hsCRP、cTnI、BNP水平,计算hsCRP、cTnI、BNP单独检测及联合检测的特异度、灵敏度、阳性预测值、阴性预测值,并进行比较.结果:与健康对照组比较,ACVD组hsCRP、cTnI及BNP水平均明显升高(P均=0.001).与治疗前比较,ACVD组治疗后hsCRP、cTnI及BNP水平均显著降低(P均=0.001);在ACVD组中,与治疗后未发生MACE组比较,MACE组hsCRP、cTnI及BNP水平均明显升高(P均=0.001);以影像学检查结果为诊断ACVD金标准,hsCRP、cTnI及BNP联合检测诊断ACVD的灵敏度、阳性预测值和阴性预测值均明显高于hsCRP、cTnI的单独检测(灵敏度:99.02% 比57.85%、72.32%,阳性预测值99.02% 比60.87%、74.31%,阴性预测值:81.81% 比49.50%、71.03%),特异度明显高于hsCRP、BNP单独检测(81.81% 比52.63%、66.67%), P<0.05或<0.01.结论:hsCRP、cTnI、BNP联合检测可准确诊断急性心血管病,评估其预后,值得应用于临床.%Objective:To explore diagnostic value of high sensitive C reactive protein(hsCRP),cardiac troponin I(cTnI) and brain natriuretic peptide(BNP)detecting for acute cardiovascular diseases(ACVD).Methods:A total of 216 ACVD patients treated in our hospital were selected as ACVD group,another 216 healthy subjects undergoing physical examination during the same period were selected as healthy control group.According to presence of major adverse cardiovascular events (MACE)after treatment,ACVD group was further divided into MACE group(n=52)and no MACE group(n=164). Levels of hsCRP,cTnI and BNP were measured and compared among all groups.Specificity,sensitivity,positive and nega-tive predictive value of single and combined detections of hsCRP,cTnI and BNP for diagnostic ACVD were calculated and compared.Results:Compared with healthy control group,there were significant rise in levels of hsCRP,cTnI and BNP in ACVD group,P=0.001 all.Compared with before treatment,there were significant reductions in levels of hsCRP,cTnI and BNP in ACVD group after treatment,P=0.001 all;in ACVD group,compared with no MACE group after treat-ment,there were significant rise in levels of hsCRP,cTnI and BNP in MACE group,P=0.001 all.With imaging exami-nation as diagnosing gold standard for ACVD,compared with single detection of hsCRP and cTnI,there were significant rise in sensitivity(57.85%,72.32% vs.99.02%),positive predictive value(60.87%,74.31% vs.99.02%)and nega-tive predictive value(49.50%,71.03% vs.81.81%)in combined detection of hsCRP,cTnI and BNP,and specificity of combined detection was significantly higher than those of single hsCRP and BNP detection(81.81% vs.52.63%, 66.67%),P<0.05 or <0.01. Conclusion:Combined detection of hsCRP,cTnI and BNP can accurately diagnose acute cardiovascular diseases,evaluate their prognosis and is worth extending.