摘要
目的分析颈部血管超声联合血清凝血酶抗凝血酶复合物(TAT)、骨形成蛋白6(BMP6)在老年冠心病颈动脉狭窄诊断中的临床价值。方法选择2022年1月至8月于我院收治的老年冠心病患者180例,根据DSA检查结果分为对照组(无颈动脉狭窄,62例)及观察组(颈动脉狭窄,118例),2组患者均行颈部血管超声检查,比较2组患者颈总动脉收缩期最大流速(PSV)、舒张末期流速(EDV)、血流阻力指数(RI);采集2组患者空腹静脉血,酶联免疫吸附法检测TAT、BMP6水平,比较2组患者TAT、BMP6水平,采用一致性检验法检测颈部血管超声检查与DSA检查诊断颈动脉狭窄的一致性;采用四格表法检测颈部血管超声检查诊断颈动脉狭窄的灵敏度、特异度。采用受试者工作特征(ROC)曲线评估颈部血管超声联合TAT、BMP6诊断老年冠心病患者颈动脉狭窄价值。结果观察组患者PSV、EDV水平明显低于对照组,RI水平明显高于对照组(P<0.05)。四格表法显示,颈部血管超声检查诊断颈动脉狭窄的灵敏度为81.4%,特异度为75.8%。一致性检验法检测显示,颈部血管超声检查与DSA检查诊断颈动脉狭窄的Kappa为0.784(P<0.001)。观察组患者血清TAT、BMP6水平明显高于对照组(P<0.05)。ROC曲线显示,TAT、BMP6、颈部血管超声诊断老年冠心病患者颈动脉狭窄的曲线下面积(AUC)分别为0.727、0.769、0.822,TAT+BMP6+颈部血管超声诊断老年冠心病患者颈动脉狭窄的AUC为0.909,联合检测预测价值较高。结论颈部血管超声检查可准确显示冠心病患者颈动脉血流动力学变化,血清TAT、BMP6在冠心病合并颈动脉狭窄患者明显异常表达,三者联合在预测冠心病颈动脉狭窄方面具有一定价值,对临床诊断与治疗具有重要意义。
Objective To analyze the clinical value of cervical vascular ultrasound combined with serum thrombin antithrombin complex(TAT)and bone morphogenetic protein 6(BMP6)in the diagnosis of carotid artery stenosis in elderly patients with coronary heart disease.Methods One hundred and eighty elderly patients with coronary heart disease admitted to our hospital from January to August 2022 were divided into the control group(no carotid stenosis,n=62)and the observation group(carotid stenosis,n=118)according to the results of digital subtraction angiography(DSA).Both patients in the two groups underwent the carotid artery ultrasound examination.The levels of the maximum systolic velocity(PSV),the end-diastolic velocity(EDV)and the blood flow resistance index(RI)of the common carotid artery in the two groups were compared.The fasting venous blood of the two groups was collected,and the levels of TAT and BMP6 were detected by enzyme-linked immunosorbent assay(ELISA).The levels of TAT and BMP6 were compared between the two groups.The consistency test was used to detect the consistency of carotid artery ultrasound and DSA in the diagnosis of carotid artery stenosis.The sensitivity and specificity of carotid artery ultrasound in the diagnosis of carotid artery stenosis were tested by the four-grid table method.The receiver operator characteristic(ROC)curve was used to evaluate the value of carotid artery ultrasound combined with TAT and BMP6 in the diagnosis of carotid artery stenosis in elderly patients with coronary heart disease.Results The levels of PSV and EDV in the observation group were significantly lower than those in the control group,and the level of RI was significantly higher than those in the control group(P<0.05).The four-grid method showed that the sensitivity and specificity of carotid artery ultrasound in the diagnosis of carotid artery stenosis were 81.4%and 75.8%,respectively.The consistency test showed that the Kappa of carotid artery stenosis diagnosed by carotid artery ultrasound and DSA was 0.784(P<0.001).The levels of serum TAT and BMP6 in the observation group were significantly higher than those in the control group(P<0.05).The ROC curve showed that the area under the curve(AUC)of TAT,BMP6 and cervical vascular ultrasound in the diagnosis of carotid artery stenosis in elderly patients with coronary heart disease were 0.727,0.769 and 0.822,respectively,and the AUC of TAT+BMP6+cervical vascular ultrasound in the diagnosis of carotid artery stenosis in elderly patients with coronary heart disease was 0.909.The combined detection had a high predictive value.Conclusion Cervical vascular ultrasound can accurately display the changes of carotid hemodynamics in patients with coronary heart disease.Serum TAT and BMP6 are significantly abnormal in patients with coronary heart disease and carotid artery stenosis.The combination of the three has certain value in predicting carotid artery stenosis in patients with coronary heart disease and has important significance for clinical diagnosis and treatment.
作者
王芳
吴娟
Wang Fang;Wu Juan(Department of Ultrasound,Sun Simiao Elderly Rehabilitation Hospital,Tongchuan 727031,China;不详)
出处
《山西医药杂志》
2023年第10期727-731,共5页
Shanxi Medical Journal
关键词
超声检查
抗凝血酶类
骨形成蛋白6
冠心病
老年人
颈动脉狭窄
诊断
Ultrasonography
Antithrombins
Bone morphogenetic protein 6
Coronary disease
Aged
Carotid Stenosis
Diagnosis
