缺血修饰白蛋白结合二维斑点追踪技术早期诊断不稳定型心绞痛
发布时间：2018-08-29 17:26
【摘要】：研究背景:长久以来,临床上对于不稳定型心绞痛(Unstable angina,UA)的诊断多依据胸痛症状及胸痛发作时心电图的ST-T改变,但大部分患者无法做到胸痛发作当时及时就医检查心电图,而来院就诊时心电图已恢复正常或心电图变化不具有诊断意义,因此如何早期诊断UA成为了目前临床上一个亟待解决的问题。近年来研究发现缺血修饰白蛋白(Ischemia modified albumin,IMA)是早期识别心肌缺血的敏感指标,但诊断特异性不高;而二维斑点追踪技术(Two-dimensional speckle tracking imaging,2D-STI)对于定量识别心肌缺血具有高度特异性,但敏感度较差。目的:利用受试者工作特征曲线(ROC曲线),探究联合应用缺血修饰白蛋白(IMA)与二维斑点追踪技术(2D-STI)参数——左室整体峰值纵向应变(GPLS)早期诊断不稳定型心绞痛(UA)的价值。方法:根据冠状动脉造影结果选取123例冠状动脉左前降支单一病变且狭窄程度≥70%并行PCI治疗的不稳定型心绞痛(UA)患者(PCI组)以及82例冠状动脉无狭窄的患者(对照组),两组于术中记录胸痛症状及胸痛发作时的标准12导联心电图,并且分别于术前及术后检测血清IMA、行超声心动图检查。应用2D-STI技术测定左心室17节段的收缩期峰值纵向应变(LS),并计算左室整体峰值纵向应变(GPLS)。应用ROC曲线确定IMA、GPLS对于UA的诊断临界值(Cut-off值)。分别采用统计学上平行诊断试验及系列诊断试验两种联合诊断方法,评价IMA联合GPLS(2D-STI)早期诊断UA的诊断价值。结果:1、PCI组术前血清IMA为43.56±9.38(U/ml),对照组术前血清IMA为44.55±8.81(U/ml),两者比较差异无统计学意义(P0.001);PCI组术后血清IMA为82.80±14.28(U/ml),对照组术后血清IMA为59.91±18.29(U/ml),两者比较差异有统计学意义(P0.001)。2、PCI组术前GPLS为-21.29±1.23(%),对照组术前GPLS为-21.47±1.53(%),两者比较差异无统计学意义(P0.001);PCI组术后GPLS为-18.20±2.74(%),对照组术后GPLS为-21.28±2.39(%),两者比较差异有统计学意义(P0.001)。3、IMA诊断UA的ROC曲线下面积为0.799[95%CI:0.734,0.864,P0.001],GPLS诊断UA的ROC曲线下面积为0.790[95%CI:0.726,0.853,P0.001];IMA联合GPLS诊断UA的ROC曲线下面积为0.900[95%CI:0.859,0.940,P0.001]。4、IMA早期诊断UA的敏感度与特异性分别为83.3%、70.7%,误诊率与漏诊率分别为29.3%、16.7%;GPLS早期诊断UA的敏感度与特异性分别为72.5%、82.9%,误诊率与漏诊率分别为17.1%、27.5%。5、平行诊断试验时,IMA联合GPLS早期诊断UA的敏感度与特异性分别为93.3%、53.7%,误诊率与漏诊率分别为46.3%、6.7%。6、系列诊断试验时,IMA联合GPLS早期诊断UA的敏感度与特异性分别为59.2%、100%,误诊率与漏诊率分别为0%、40.8%。结论:1、IMA联合GPLS(2D-STI)早期诊断UA的诊断准确度高于IMA、GPLS(2D-STI)分别各自早期诊断UA。2、IMA联合GPLS(2D-STI)采用平行诊断试验可以提高早期诊断UA的敏感度,降低漏诊率;IMA联合GPLS(2D-STI)采用系列诊断试验可以提高早期诊断UA的特异性,降低误诊率。3、临床上对于UA的早期诊断旨在降低漏诊率,可以采用平行诊断试验联合IMA与2D-STI以早期诊断UA。
[Abstract]:BACKGROUND: For a long time, clinical diagnosis of unstable angina (UA) has been based on the symptoms of chest pain and ST-T changes of electrocardiogram during chest pain attacks. However, most of the patients can not get timely examination of electrocardiogram at the time of chest pain attacks, and the electrocardiogram has returned to normal at the time of hospitalization. In recent years, it has been found that ischemia modified albumin (IMA) is a sensitive marker for early detection of myocardial ischemia, but its diagnostic specificity is not high; and two-dimensional speckle tracking imagine (two-dimensional speckle tracking imagine) is an important technique for early detection of myocardial ischemia. Objective: To explore the early diagnosis of unstable angina pectoris (UA) by combining ischemic modified albumin (IMA) with two-dimensional speckle tracking technique (2D-STI), i.e. global peak longitudinal strain of the left ventricle (GPLS). Methods: 123 patients with unstable angina pectoris (UA) and 82 patients without coronary artery stenosis (control group) with single lesion of left anterior descending coronary artery (LAD) and more than 70% stenosis were selected according to the results of coronary angiography. The peak systolic longitudinal strain (LS) of 17 segments of the left ventricle was measured by two-dimensional STI technique and the global peak longitudinal strain (GPLS) of the left ventricle was calculated. The diagnostic value of IMA combined with GPLS (2-D-STI) in early diagnosis of UA was evaluated by diagnostic test and serial diagnostic test. Results: 1. The preoperative serum IMA of PCI group was 43.56 (+9.38) U/ml, while that of control group was 44.55 (+8.81) U/ml. There was no significant difference between the two methods (P 0.001); the postoperative serum IMA of PCI group was 82.80 (+14.28) U/ml, respectively. The serum IMA of the control group was 59.91 (+18.29) (U/ml), and the difference was statistically significant (P 0.001). The GPLS of the PCI group was -21.29 (%) and the control group was - 21.47 (%) before operation. The difference was not statistically significant (P 0.001); the GPLS of the PCI group was - 18.20 (%) and the control group was - 21.28 (%) after operation. The area under the ROC curve of IMA was 0.799 [95% CI: 0.734, 0.864, P 0.001], the area under the ROC curve of GPLS was 0.790 [95% CI: 0.726, 0.853, P 0.001], and the area under the ROC curve of IMA combined with GPLS was 0.900 [95% CI: 0.859, 0.940, P 0.001]. 4, the sensitivity and specificity of IMA for early diagnosis of UA were 83.3%, respectively. The sensitivity and specificity of GPLS for early diagnosis of UA were 72.5%, 82.9%, 17.1% and 27.5% respectively. The sensitivity and specificity of IMA combined with GPLS for early diagnosis of UA were 59.2%, 100%, misdiagnosis rate and missed diagnosis rate were 0% and 40.8%, respectively. Conclusion: 1. IMA combined with GPLS (2D-STI) for early diagnosis of UA was more accurate than IMA, GPLS (2D-STI) for early diagnosis of UA was higher than IMA, GPLS (2D-STI) for early diagnosis of UA was higher than IMA combined with GPLS (2D-STI). The sensitivity of early diagnosis of UA and the rate of missed diagnosis can be reduced. The combination of IMA and GPLS (2D-STI) can improve the specificity of early diagnosis of UA and reduce the rate of misdiagnosis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
本文编号：2211904
[Abstract]:BACKGROUND: For a long time, clinical diagnosis of unstable angina (UA) has been based on the symptoms of chest pain and ST-T changes of electrocardiogram during chest pain attacks. However, most of the patients can not get timely examination of electrocardiogram at the time of chest pain attacks, and the electrocardiogram has returned to normal at the time of hospitalization. In recent years, it has been found that ischemia modified albumin (IMA) is a sensitive marker for early detection of myocardial ischemia, but its diagnostic specificity is not high; and two-dimensional speckle tracking imagine (two-dimensional speckle tracking imagine) is an important technique for early detection of myocardial ischemia. Objective: To explore the early diagnosis of unstable angina pectoris (UA) by combining ischemic modified albumin (IMA) with two-dimensional speckle tracking technique (2D-STI), i.e. global peak longitudinal strain of the left ventricle (GPLS). Methods: 123 patients with unstable angina pectoris (UA) and 82 patients without coronary artery stenosis (control group) with single lesion of left anterior descending coronary artery (LAD) and more than 70% stenosis were selected according to the results of coronary angiography. The peak systolic longitudinal strain (LS) of 17 segments of the left ventricle was measured by two-dimensional STI technique and the global peak longitudinal strain (GPLS) of the left ventricle was calculated. The diagnostic value of IMA combined with GPLS (2-D-STI) in early diagnosis of UA was evaluated by diagnostic test and serial diagnostic test. Results: 1. The preoperative serum IMA of PCI group was 43.56 (+9.38) U/ml, while that of control group was 44.55 (+8.81) U/ml. There was no significant difference between the two methods (P 0.001); the postoperative serum IMA of PCI group was 82.80 (+14.28) U/ml, respectively. The serum IMA of the control group was 59.91 (+18.29) (U/ml), and the difference was statistically significant (P 0.001). The GPLS of the PCI group was -21.29 (%) and the control group was - 21.47 (%) before operation. The difference was not statistically significant (P 0.001); the GPLS of the PCI group was - 18.20 (%) and the control group was - 21.28 (%) after operation. The area under the ROC curve of IMA was 0.799 [95% CI: 0.734, 0.864, P 0.001], the area under the ROC curve of GPLS was 0.790 [95% CI: 0.726, 0.853, P 0.001], and the area under the ROC curve of IMA combined with GPLS was 0.900 [95% CI: 0.859, 0.940, P 0.001]. 4, the sensitivity and specificity of IMA for early diagnosis of UA were 83.3%, respectively. The sensitivity and specificity of GPLS for early diagnosis of UA were 72.5%, 82.9%, 17.1% and 27.5% respectively. The sensitivity and specificity of IMA combined with GPLS for early diagnosis of UA were 59.2%, 100%, misdiagnosis rate and missed diagnosis rate were 0% and 40.8%, respectively. Conclusion: 1. IMA combined with GPLS (2D-STI) for early diagnosis of UA was more accurate than IMA, GPLS (2D-STI) for early diagnosis of UA was higher than IMA, GPLS (2D-STI) for early diagnosis of UA was higher than IMA combined with GPLS (2D-STI). The sensitivity of early diagnosis of UA and the rate of missed diagnosis can be reduced. The combination of IMA and GPLS (2D-STI) can improve the specificity of early diagnosis of UA and reduce the rate of misdiagnosis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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，本文编号：2211904
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