目的 探讨血清高敏C反应蛋白(hs-CRP)联合踝臂指数(ABI)在原发性高血压患者发生无症状心肌缺血(SMI)中的诊断价值.方法 依据157例轻中度原发性高血压患者24小时动态心电图(Holter),异常者行冠状动脉造影,将所有患者分为SMI组(35例)和对照组(122例).收集患者的一般临床指标,测定血清ha-CRP水平,并进行ABI测量.结果 与对照组相比,S7u1I组血清hs-CRP水平升高[(3.38±1.74)mg/L vs(1.76±1.24)m岁L,P=0.00];ABI水平降低[(0.97±0.14)vs(1.04±0.13),P=0.004].绘制ROC曲线,hs-CRP和ABI对SMI的诊断具低至中等预测价值,其截断点分别为2.10 mg/L和0.96.hs-CRP联合ABI诊断SMI的灵敏度为88.5%,特异度为93.4%,阳性预测值为82.1%,阴性预测值为95.9%,误诊率为6.5%,漏诊率为1.2%.结论 原发性高血压患者有较高的SMI患病率;SMI的发生与hs-CRP和ABI相关,hs-CRP 和ABI两者联合对SMI有更高的诊断价值,可能成为检测高血压病合并SMI的有效手段.%Objective To assess the predictive value of high sensitivity C-reactive protein ( hsCRP) and ankle-brachial index(ABI) to diagnose silent myocardial ischemia(SMI) in patients with essential hypertension. Methods We designed a cross-sectional study with 157 mild or moderate essential hypertension patients having no known coronary heart disease. Ischemia was assessed by Holter and coronary arteriography. 157 patients were separated SMI group( n = 35 ) and control group( n = 122). All enrolled patients underwent measurement of serum hs-CRP concentrations and ABI. Results Compared with control group, higher hs-CRP levels [ (3.38 ± 1.74) mg/L vs ( 1.76 ± 1.24) mg/L,P = 0.00 ] and lower ABI [ (0.97 ±0.14) vs (1.04 ±0.13) ,P =0.004] were observed in SMI group. ROC curve was drawn in patients with SMI. Hs-CRP and ABI had low or moderate predictive values with their cut-off points of 2.10 mg/L and 0. 96, respectively. For the combination of hs-CRP and ABI, the sensitivity was 88.5 ％,the specificity was 93.4％ ,positive predictive value was 82. 1％ ,negative predictive value was 95.9％,the rate of misdiagnosis and missed diagnosis was 6.5％ and 1.2％. Conclusion SMI shows a relatively high prevalence in patients with essential hypertension. Hs-CRP and ABI was associated with SMI, and the combination of hs-CRP and ABI increases the diagnostic value. They might help detect SMI in patients with essential hypertension.
展开▼
