脂蛋白相关磷酯酶A2、D二聚体、C反应蛋白及外周血嗜中性粒细胞绝对值联合检测对急性脑血栓形成的诊断价值

摘要

Objective:To investigate the diagnostic value of the combinations of the Lipoprotein Associated Phosphlipase(Lp-PLA2, D-dimer(DD),Hypersensitive C reactive protein(hsCRP), Neutrophils Absolute Value(Neu)in acute cerebral thrombosis(ACT). Methods:Selected the Neurological outpatients at their first visit to the second people's hospital of Foshan from January,2014 to August,2014.Suspicious ACT patients were diagnosed by medical history, symptoms and physical check,and suspicious ACT patients were classified into ACT patients(n=65) and non-ACT patients(n=50) following the diagnosed gold criteria.The concentration of LP-PLA2 was determined by Enzyme-linked immunosorbent assy .The concentration of hsCRP and DD were determined by immuneoturbidimetry.Neu was determined by Blood Cell Analyzer(BCA).The assessed parameters of diagnostic value were measured using the evidence-based laboratory medicine.Results: The concentration of LP-PLA2,ln(hsCRP),ln(DD) and Neu in ACT group were significantly higher than that of in non-CT group[(250.62±145.60)ng/ml vs (152.94±59.01)ng/ml;(2.84±0.33)ng/ml vs (2.06±0.26)ng/ml;(0.55±0.22)mg/l vs (0.24±0.08)mg/l;(4.23±2.05)×10-9/L vs (3.02±1.38)×10-9/l,P<0.05].Diagnosed Threshold of LP-PLA2,hsCRP,DD and Neu in ACT group or non-ACT group were 173.5ng/ml,330.0ng/ml, 1.99mg/ml and 3.27×109/L respectively.The diagnostic sensitivety of four Parallel test combinations was the highest (95.4%) in all combinations.The diagnostic specificity of four serial test combinations was the highest (98.0%) in all combinations.The diagnostic sensitivety for Parallel test combinations of DD and Neu was 90.8% and its false negative rate was 9.2%.The diagnostic specitivety for serial test combinations of DD and hsCRP was 94.0% and its false positive rate was 6.0%.Conclusions: Taking the detection cost and convenience of single test into consideration,Parallel test combinations of DD and Neu was the most efficient as performance index of except ACT.Serial test combinations of DD and hsCRP was the most efficient as performance index of diagnosed ACT.%目的：探讨脂蛋白相关磷酯酶A2(Lipoprotein Associated Phospholipase A2,Lp-PLA2)、D二聚体(D Dimer,DD）、高敏C-反应蛋白(Hypersensitive C Reative Protein,hsCRP)、外周血嗜中性粒细胞绝对值(Neutrophils Absolute Value，Neu)联合检测对急性脑血栓形成(Cerebral Thrombosis，CT)的诊断价值。方法：选取2014年1月至2014年8月佛山市第二人民医院神经内科/外科门诊初诊患者,通过病史、症状和体查拟诊为疑似脑CT患者，再采用诊断金标准将疑似患者(研究对象)确诊分为脑CT(65例)和非脑CT组(50例)。LP-PLA2测定用双抗体夹心ELISA法，DD和hsCRP测定用免疫比浊法，Neu测定用血细胞分析仪法。采用循证检验医学的方法统计各联合指标的诊断价值性能指标。结果：脑CT组Lp-PLA2、DD的ln值、hsCRP的ln值及Neu明显高于非脑CT组[(250.62±145.60)ng/ml vs (152.94±59.01)ng/ml；(2.84±0.33)ng/ml vs (2.06±0.26)ng/ml；(0.55±0.22)mg/l vs (0.24±0.08) mg/l；(4.23±2.05)×10-9/L vs (3.02±1.38)×10-9/l，P<0.05]。Lp-PLA2、DD、hsCRP和Neu对脑CT具有最高诊断正确率的诊断界值分别为173.5ng/ml、330.0ng/ml、1.99mg/ml和3.27×109/L，依据指标联合诊断价值四格表获得指标并联和串联的各诊断价值参数，4指标并联灵敏度95.4%(漏诊率4.6%)为最高，4指标串联特异性98.0%(误诊率2.0%)为最高，综合考虑单一指标的检测成本和操作方便性，DD和Neu并联灵敏度90.8%(漏诊率9.2%)为最佳，DD和hsCRP串联的特异性94.0%(误诊率4.0%)为最佳。结论：在目前所选择研究指标中,DD+Neu并联是最佳脑CT筛查联合指标，DD+hsCRP串联是最佳脑CT确诊联合指标。