ROC曲线评价缺血修饰白蛋白、高敏肌钙蛋白Ⅰ联合检测在急性冠脉综合征早期诊断中的应用

摘要

Objective To evaluate the diagnostic value of combined detection of ischemia modified albumin (IMA) and high-sensitivity troponin I (hs-TnI) in acute coronary syndrome (ACS) by using ROC curve.Methods 31 cases of acute coronary syndrome(ACS),31 cases of non-ischemic chest pain group which had been confirmed by coronary angiography,and 31 cases of healthy controls were involved in this study.The serum levels of IMA,hs-TnI,Myo,TnI and CKMB were measured,and the Logistic regression model and the ROC curves were used to evaluate the diagnostic value for ACS.Results The AUC of ROC curve for IMA and hs-TnI were 0.840 and 0.945 respectively.The AUC of the "IMA + hs-TnI" combination for ACS was 0.967.The diagnostic sensitivity and specificity was 90.3％ and 93.5％,respectively,which was higher than that any of the biomarkers alone and the combination of "TnI + Myo + CKMB".Conclusion IMA and hs-TnI both have certain value for diagnosing ACS.The combination of IMA and hs-TnI plays a better role in diagnosing ACS than that either IMA,hs-TnI alone or the "TnI + Myo + CKMB" combination.%目的 运用ROC曲线分析缺血修饰白蛋白(IMA)、高敏肌钙蛋白Ⅰ(hs-TnI)联合检测在急性冠脉综合征早期诊断中的应用价值.方法 选择我院经冠状动脉造影确诊的、发病至采血时间间隔在3h以内的急性冠脉综合征(ACS)患者31例,分别检测血清IMA和hs-TnI水平.另选择31例同期经冠状动脉造影排除急性冠脉综合征胸痛患者作为非缺血性胸痛(NICP)患者组,31名外表健康的体检人员作为对照组.应用Logistic回归模型,绘制“IMA+ hs-TnI”联合检测诊断急性冠脉综合征的ROC曲线,获得相应诊断效能参数,并与肌红蛋白等其它心肌标志物对比,评价IMA和hs-TnI用于急性冠脉综合征早期诊断的临床价值.结果 发病3h内,IMA诊断ACS的曲线下面积为0.840,hs-TnI为0.945.“IMA+hs-TnI”联合检测的曲线下面积为0.967,敏感性为90.3％,特异性为93.5％,高于IMA或hs-TnI单独检测及“TnI+ Myo+CKMB”联合检测.结论 IMA和hs-TnI联合检测时可以发挥较好的互补作用,对发病3h内ACS的诊断具有较高的特异性和敏感性,且高于“TnI+ Myo+ CKMB”联合检测.