摘要
目的探讨能谱CT冠状动脉血管成像(CCTA)检查联合血清脂蛋白a[Lp(a)]、脂肪型丝氨酸蛋白酶抑制剂(Vaspin)、和肽素(Copetin)水平检测对急性冠脉综合征(ACS)的诊断价值。方法选取2017年2月至2019年12月该院收治的132例ACS患者[不稳定型心绞痛(UAP)组69例,急性心肌梗死(AMI)组63例]和85例稳定型心绞痛(SAP)患者作为研究对象,对所有患者进行CCTA和冠状动脉造影(CAG)检查,以及Lp(a)、Vaspin和Copetin水平检测;以临床最终结果为诊断标准,比较CAG和CCTA检查对罪犯血管的诊断结果,比较不同组间CCTA检查参数,以及Lp(a)、Vaspin和Copetin水平;建立Lp(a)、Vaspin及Copetin水平的二元Logistic回归预测模型,采用受试者工作特征曲线(ROC曲线)分析Lp(a)、Vaspin及Copetin联合检测对ACS的诊断效能。结果CAG和CCTA检查对罪犯血管的诊断差异无统计学意义(P>0.05);在CCTA检查对罪犯血管的诊断中,SAP组血管狭窄程度多<50%,以单支病变为主,而ACS组血管狭窄多>75%~99%,以多支病变为主,组间比较差异均有统计学意义(P<0.05);在ACS组内,AMI组血管狭窄程度>75%~99%明显大于UAP组,UAP组罪犯相关血管多位于回旋支,而AMI组多位于前降支,差异均有统计学意义(P<0.05);SAP组脂质斑块少见,ACS组脂质斑块和纤维斑块等非钙化斑块多见,差异有统计学意义(P<0.05)。ACS组中的AMI组与SAP组间Lp(a)水平比较,差异均有统计学意义(P<0.05);ACS组中的UAP组和AMI组Vaspin水平均明显低于SAP组,Copetin水平均明显高于SAP组,差异均有统计学意义(P<0.05);在ACS组内,AMI组Vaspin、Copetin水平均明显低于UAP组,差异均有统计学意义(P<0.05)。Lp(a)、Vaspin及Copetin联合检测诊断患者是否发生ACS的曲线下面积为0.973(95%CI:0.953~0.993,P<0.01),其灵敏度为93.2%,特异度为97.7%,阳性预测值为98.4%,阴性预测值为90.2%,约登指数为0.91,正确指数为94.9%。结论CCTA检查联合血清Lp(a)、Vaspin、Copetin水平检测可有效提高ACS的确诊率,对早期预测诊断ACS有一定的临床价值。
Objective To investigate the diagnostic value of coronary CT angiography(CCTA)examination combined with serum lipoprotein a[Lp(a)],Vaspin and Copetin in acute coronary syndrome(ACS).Methods A total of 132 patients with ACS in the hospital from February 2017 to December 2019[69 patients in unstable angina pectoris(UAP)group,63 patients in acute myocardial infarction(AMI)group]and 85 patients with stable angina pectoris(SAP)were selected as research objects.All patients were examined by CCTA and coronary angiography(CAG)and Lp(a),Vaspin and Copetin levels were detected.Taking the final clinical results as the diagnostic criteria,the diagnosis results of culprit vessels by CAG and CCTA examinations were compared,and the CCTA examination parameters and the levels of Lp(a),Vaspin and Copetin were compared between different groups.The binary Logistic regression prediction model of Lp(a),Vaspin and Copetin levels was established,and the diagnostic efficiency of the combined detection of Lp(a),Vaspin and Copetin for ACS was analyzed by receiver operating characteristic curve(ROC curve).Results There was no statistical difference between CAG and CCTA examinations in the diagnosis of culprit vessels(P>0.05).In the diagnosis of culprit vessels by CCTA examination,the degree of vascular stenosis in SAP group was less than 50%,mainly single vessel lesions,while in ACS group,it was>75%-99%,mainly multi vessel lesions,and the differences between the groups were statistically significant(P<0.05).In ACS group,the degree of vascular stenosis in AMI group was significantly higher than that in UAP group,the culprit related vessels in UAP group were mostly located in the circumflex branch,while those in AMI group were mostly located in the anterior descending branch,and the differences between the groups were statistically significant(P<0.05).Lipid plaques were rare in SAP group,while non calcified plaques such as lipid plaques and fibrous plaques were common in ACS group,and the difference was statistically significant(P<0.05).There was significant difference on the level of Lp(a)between AMI group and SAP group(P<0.05).Vaspin levels in UAP group and AMI group of ACS group were significantly lower than that in SAP group,and Copetin level was significantly higher than that in SAP group,and the differences were statistically significant(P<0.05).In ACS group,the Vaspin and the Copetin levels in AMI group were significantly lower than those in UAP group,and the differences were statistically significant(P<0.05).The area under the curve of the combined detection of Lp(a),Vaspin and Copetin for diagnosing the occurrance of ACS was 0.973(95%CI:0.953-0.993,P<0.01),the sensitivity was 93.2%,the specificity was 97.7%,the positive predictive value was 98.4%,the negative predictive value was 90.2%,the youden index was 0.91 and the correct index was 94.9%.Conclusion The combined detection of CCTA examination,serum LP(a),Vaspin and Copetin could effectively improve the diagnostic rate of ACS.It has a certain clinical value for early prediction and diagnosis of ACS.
作者
王磊
司晔巍
曹秋梅
WANG Lei;SI Yewei;CAO Qiumei(Department of Emergency,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100176,China)
出处
《国际检验医学杂志》
CAS
2022年第20期2446-2451,共6页
International Journal of Laboratory Medicine
基金
北京市自然科学基金资助项目(7172341)。
