2019 年第 5 期 第 14 卷

血清缺血修饰白蛋白和同型半胱氨酸与冠状动脉粥样硬化性心脏病的相关性及联合检测对疾病的临床诊断价值

Correlation among serum ischemic modified albumin, homocysteine and coronary atherosclerotic heart disease and the diagnostic value of combined detection

作者：付建平张羽徐彬郑群张慧晶

英文作者：

单位：053000河北省衡水市人民医院哈励逊国际和平医院心内科

英文单位：

关键词：冠状动脉粥样硬化性心脏病；缺血修饰白蛋白；同型半胱氨酸；诊断价值

英文关键词：

• 摘要：

• 【摘要】目的    研究血清缺血修饰白蛋白（IMA）和同型半胱氨酸（Hcy）与冠状动脉粥样硬化性心脏病（冠心病）的相关性，并分析两项指标联合检测对冠心病临床诊断价值。方法    选取河北省衡水市人民医院2015年3月至2018年7月收诊的126例冠心病患者作为观察组，其中ST段抬高型急性冠状动脉综合征（STEACS）28例，非ST段抬高型急性心肌梗死（NSTEMI）32例，不稳定型心绞痛（UAP）30例，稳定型心绞痛（SAP）36例；单支病变33例，双支病变48例，多支病变45例；另选取同期体检者120名作为对照组，检测血清IMA、Hcy水平。分析血清IMA、Hcy水平与冠心病类型、冠状动脉病变程度的相关性，比较血清IMA、Hcy联合及单独检测的诊断价值。结果    UAP、NSTEMI、STEACS患者血清IMA、Hcy水平明显高于SAP患者和体检者［（87±12）、（110±11）、（122±13）kU/L比（70±10）、（68±10）kU/L，（15.7±2.5）、（21.7±3.1）、（26.6±3.5）μmol/L比（10.0±1.2）、（9.4±1.0）μmol/L］，差异均有统计学意义（均P＜0.05）。多支病变者血清IMA、Hcy水平较双支、单支病变者高［（92±6）kU/L比（86±5）、（80±5）kU/L，（16.3±1.2）μmol/L比（11.8±1.6）、（10.5±1.3）μmol/L］，且双支病变者高于单支病变者，差异均有统计学意义（均P＜0.05）。Spearman相关性分析结果显示，血清IMA水平与冠心病类型（病情由轻到重）（r＝0.803，P＜0.001）、冠状动脉病变支数（r＝0.512，P＝0.008）均呈正相关；血清Hcy水平与冠心病类型（病情由轻到重）（r＝0.745，P＜0.001）、冠状动脉病变支数（r＝0.486，P＝0.013）均呈正相关。血清IMA联合Hcy检测的诊断敏感度较IMA和Hcy单独检测（96.03%比81.75%、76.19%）高，诊断准确率亦较单独检测（84.96%比77.64%、75.61%）高，差异均有统计学意义（均P＜0.05），而诊断特异度与二者单独检测比较差异无统计学意义（P＞0.05）。结论    血清IMA、Hcy水平在CHD患者中呈现异常高表达状态，与冠心病类型（病情由轻到重）、冠状动脉病变支数具有正相关关系，二者联合检测可在不影响诊断特异度基础上提高诊断准确率、敏感度，为临床准确判断冠心病类型、病情程度、制定合理治疗方案及评估预后情况提供有力信息支持。

• 【Abstract】Objective    To investigate the correlation among serum ischemic modified albumin(IMA), homocysteine(Hcy) and coronary atherosclerotic heart disease（CHD） and the diagnostic value of combined detection of IMA and Hcy for CHD. Methods    From March 2015 to July 2018, 126 CHD patients including 28 cases of ST-segment elevation acute coronary syndrome(STEACS), 32 cases of non-ST-segment elevation acute myocardial infarction(NSTEMI), 30 cases of unstable angina pectoris(UAP), 36 cases of stable angina pectoris(SAP), 33 cases of single-vessel disease, 48 cases of dual-vessel disease, 45 cases of multi-vessel disease, and 120 healthy people were enrolled in People′s Hospital of Hengshui. Serum levels of IMA and Hcy were measured. Correlations of IMA and Hcy with the type and severity of CHD were analyzed. Diagnostic values of combined and separate detection of IMA and Hcy were analyzed. Results    Levels of serum IMA and Hcy in patients with UAP, NSTEMI and STEACS were significantly higher than those in SAP and healthy subjects［（87±12）,（110±11）,（122±13）kU/L vs （70±10）,（68±10）kU/L; （15.7±2.5） （21.7±3.1）,（26.6±3.5）μmol/L vs （10.0±1.2）,（9.4±1.0）μmol/L］(all P＜0.05). Levels of serum IMA and Hcy increased among patients with single-vessel disease, dual-vessel and multi-vessel disease［（80±5）kU/L vs （86±5）,（92±6）kU/L; （10.5±1.3）μmol/L vs （11.8±1.6）, （16.3±1.2）μmol/L］ (all P＜ 0.05). Spearman analysis showed that serum IMA level was positively correlated with the type（from mild to severe） and severity（number of lesions） of CHD（r＝0.803, P＜0.001; r＝0.512, P＝0.008）; serum Hcy level was positively correlated with the type and severity of CHD（r＝0.745, P＜0.001; r＝0.486, P＝0.013）. Combined detection of IMA and Hcy showed higher diagnostic specificity and accuracy than IMA to Hcy separate detection（96.03% vs 81.75%, 76.19%; 84.96% vs 77.64%, 75.61%）(all P＜0.05) but there was no significant difference of diagnostic specificity among them(P＞0.05). Conclusions    CHD patients have abnormally elevated levels of serum IMA and Hcy, which are positively correlated with the type and severity of disease. Combined detection of IMA and Hcy can improve the diagnostic accuracy and sensitivity without affecting the specificity, providing powerful reference for clinical identification, illness evaluation, reasonable therapeutic choice and prognostic prediction of CHD.