目的 应用Logistic回归和ROC曲线探讨可溶性Lox-1、肌钙蛋白I、肌酸激酶同工酶、肌红蛋白及超敏C反应蛋白单独或联合检测对急性冠脉综合征的诊断价值.方法 收集经冠状动脉造影确诊的冠心病患者119例,其中急性冠脉综合征组78例、稳定型心绞痛组41例;另收集经冠状动脉造影证实冠脉无狭窄者41例为非冠心病组.分别检测可溶性Lox-1、肌钙蛋白I、肌酸激酶同工酶、肌红蛋白及超敏C反应蛋白浓度.应用Logistic回归模型,绘制ROC曲线,获得单独或联合检测时的曲线下面积等诊断效能参数,进而评价各指标用于急性冠脉综合征的诊断价值.结果 sLox-1诊断ACS时的曲线下面积为0.934,95%CI(0.894～0.975).上述5种生化标志物水平与诊断ACS的相关程度为sLox-1>Myo>cTnI>CK-MB>hs-CRP;"sLox-1+肌钙蛋白I+肌红蛋白"联合检测的曲线下面积为0.987[95%CI(0.974～1.000)],敏感度为93.9%,特异度为96.2%,高于上述生化标志物单独检测及"肌钙蛋白I+肌红蛋白+CK-MB"联合检测.结论 sLox-1用于ACS的诊断具有一定临床意义,与肌钙蛋白I和肌红蛋白进行联合检测时可以发挥较好的互补作用,与单独检测相比诊断效能大大提高,且高于"肌钙蛋白I+肌红蛋白+CK-MB"联合检测.%Objective Using the Logistic regression and the ROC curve to evaluate the diagnostic value of soluble Lox-1, cTnl, Myo,CK-MB,hsCRP to ACS,both alone and combinated. Methods 119 patients with coronary heart disease which had been confirmed by coronary angiography were included in this study,including acute coronary syndrome group(78 cases) and stable angina group(41 cases). Another group included 41 cases without coronary heart disease, which had also been confirmed by coronary angiography. Concentrations of sLox-1 ,Myo,cTnI,CK-MB and hs-CRP were measured,and the Logistic regression model and the ROC curves were used to evaluate the diagnostic value for ACS. Results For sLox-1 ,the area under the ROC curve was 0. 934[95%CI (0. 894 - 0. 975)]. The diagnostic relevance of the five biochemical markers for ACS was sLox-l>Myo>cTnI>CK-MB>hs-CRP. The area under the ROC curve of the "sLox-l + cTnI+Myo" combination for ACS was 0. 987[95%CI(0. 974 - 1. 000)]. The diagnostic sensitivity and specificity were 93. 9% and 96. 2% , respectively, which is higher than any of the biomarkers alone and the combination of "Myo+cTnl+CK-MB". Conclusion sLox-1 has certain value for diagnosing ACS. "sLox-l + cTnI+Myo" combination plays a better role in diagnosing ACS than sLox-1 alone and the "Myo+cTnl+CK-MB" combination.
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