联合检测血清Hcy和Lp (a)与UA对冠心病患者预后评估的价值探讨

摘要

目的 探讨血清同型半胱氨酸(Hcy)、脂蛋白a[Lp(a)]和尿酸(UA)联合检测对冠状动脉粥样硬化性心脏病(CHD)的病情及预后的评估价值.方法 选取CHD患者96例(疾病组)和体检健康者50例(正常组),采集清晨空腹静脉血,检测血清Hcy、Lp(a)和UA.观察组(疾病组)随访1年,91例病情缓解或无进展,5例发展为急性心肌梗死(AMI).采用受试者工作特征曲线分析血清Hcy、Lp(a)和UA单独及联合检测对CHD患者预后的诊断价值.结果 疾病组血清Hcy、Lp(a)和UA水平均高于正常组(均P＜ 0.05);随访发展为AMI患者入院时血清Hcy、Lp(a)和UA水平均高于病情缓解或无进展者(均P＜ 0.01).Hcy、Lp(a)和UA联合检测对CHD患者预后评估的AUC为0.855、敏感性为89.4％、特异性为80.2％、阳性预测值86.4％,均高于3项单独检测.结论 冠状动脉粥样硬化性心脏病患者血清Hcy、Lp (a)和UA水平均升高,其水平变化可反映冠状动脉粥样硬化性心脏病病情,三者联合检测可提高对患者预后的判断价值.%Objective To explore the value of the combined detection of serum Hcy,Lp (a),and UA in the evaluation of the prognosis of patients with coronary heart disease (CHD).Methods 96 patients with CHD were selected as a disease group and 50 healthy people undertaking physical examination a normal group.Both groups' fasting venous blood were collected at morning and the serum level of Hcy,Lp (a),and UA were detected.The disease group were followed up 1 year and 91 patients were relieved or got no progress in the disease and 5 developed into acute myocardial infarction (AMI).Receiver operating characteristic curve was used to analyze the value of Hcy,Lp(a),and UA and the combination of the three in the evaluation of the prognosis of the patients with CHD.Results The serum levels of Hcy,Lp(a),and UA were higher in the disease group than in the normal group and were in the patients with AMI than in those whose disease conditions were relieved or with no progress.The AUC,sensibility,specificity,and positive predicted value of the combination of Hcy,Lp(a),and UA for evaluating the prognosis of CHD patients were 0.855,89.4％,80.2％,and 86.4％,which were higher than those of Hcy,Lp(a),or UA.Conclusions CHD patients' serum levels of Hcy,Lp(a),and UA are higher than normal people's;their changes can reflect the condition of CHD.The combined detection of serum Hcy,Lp (a),and UA has high value in evaluating the patients' prognosis.