摘要
目的评估血浆中嗜铬粒蛋白A(CGA)水平诊断急性ST段抬高型心肌梗死(STEMI)的价值及预测主要不良心血管事件(MACE)中的效能。方法随机选取120例STEMI患者(观察组)和50例不稳定心绞痛患者(对照组),比较两组血浆CGA和肌钙蛋白T(CTN-T)水平,分析CGA诊断ASTEMI的特异度及敏感度。同时根据患者出院后6个月内发生MACE情况分为MACE组(36例)和非MACE组(84例),比较两组临床相关指标,采用多因素Logistic回归分析影响MACE发生的因素,绘制ROC曲线评估血浆CGA独立或联合预测ASTEMI患者出院6个月内发生MACE的价值。结果与对照组比较,观察组CGA水平在胸痛时间<4 h出现明显的升高,差异有统计学意义(P<0.05)。CGA水平在4 h内诊断STEMI的曲线下面积(AUC)为0.90,最佳阈值为125.75 ng/mL,敏感度为91.67%,特异度为84.00%;随着观察组患者冠脉狭窄程度的升高血浆CGA水平也逐渐升高。与非MACE组比较,MACE组在肌钙蛋白下降速率、总胆固醇水平、住院时间、Gensini评分、出院前CGA水平差异有统计学意义(P<0.05);出院前CGA水平预测6个月内发生MACE的AUC为0.90,最佳阈值为128.60 ng/mL,敏感度为94.44%,特异度为85.71%;Gensini评分预测6个月内发生MACE的AUC为0.98,最佳阈值为38分,敏感度为94.44%,特异度为90.48%,两者联合预测的AUC为0.98,敏感度为94.44%,特异度为95.24%。结论CGA水平在STEMI患者胸痛<4 h具有较好的诊断特异度及敏感度,出院前CGA、Gensini能够独立预测STEMI患者发生MACE的风险,两者联合可获得更高的预测效能。
Objective To evaluate the level of chromogranin A(CGA)in plasma for the diagnosis of acute ST-segment elevation myocardial infarction(STEMI)patients and its effectiveness in predicting major adverse cardiovascular events(MACE).Methods Subsequently,120 STEMI patients(the observation group)and 50 unstable angina patients(the control group)were selected to compare the levels of plasma CGA and troponin T(CTN-T)between the two groups,and receiver operating characteristic(ROC)curve analysis was performed to determine the specificity and sensitivity of CGA in diagnosing ASTEMI.At the same time,based on the occurrence of MACE within six months of discharge,patients were divided into the MACE group(36 cases)and the non MACE group(84 cases).Clinical related indicators were compared between the two groups,and univariate analysis was used to predict the occurrence of MACE in the observation group patients within six months of discharge.Multivariate logistic regression analysis was used to draw ROC curves to evaluate the predictive value of plasma CGA alone or in combination for MACE occurrence in ASTEMI patients within six months of discharge.Results Compared with the control group,the observation group showed a significant increase in CGA levels within 4 hours of chest pain,and the difference was statistically significant.The area under the curve(AUC)was 0.90,the optimal threshold was 125.75 ng/mL,the sensitivity was 91.67%,and the specificity was 84.00%.However,there was no significant difference in CTN-T within 4 hours.As the degree of coronary stenosis in the observation group increased,plasma CGA levels also gradually increased.Compared with the non MACE group,there were statistically significant differences(P<0.05)in the rate of troponin depletion,total cholesterol levels,length of hospital stay,Gensini score,and CGA levels before discharge in the MACE group.Multivariate logistic regression showed that the AUC of CGA level before discharge was 0.90,the optimal threshold was 128.60 ng/mL,the sensitivity was 94.44%,and the specificity was 85.71%.The AUC of Gensini score was 0.98,the optimal threshold was 38,the sensitivity was 94.44%,and the specificity was 90.48%.The AUC of CGA combined with Gensini score before discharge was 0.98,the sensitivity was 94.44%,and the specificity was 95.24%.Conclusion CGA levels have good diagnostic specificity and sensitivity in STEMI patients with chest pain<4 h.Before discharge,CGA and Gensini scores can independently predict the risk of MACE in STEMI patients,and the combination of the two can achieve higher predictive power.
出处
《浙江临床医学》
2024年第10期1539-1541,共3页
Zhejiang Clinical Medical Journal
基金
嘉兴市科技计划项目(2022AD30069)
嘉兴市医学重点学科-临床诊断学(支撑学科)(2023-ZC-002)。
