Hcy、NT-proBNP、D-dimer联合检测对急性脑梗死诊断的应用价值
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摘要
目的探讨血清Hcy和NT-proBNP以及血浆D-dimer联合检测在急性脑梗死(ACI)中的诊断价值。方法选取2016年9月至2017年9月间我院神经内科收治急性脑梗死患者73例为实验组,同时选取同一时期健康体检者50例为对照组。采用循环酶法、化学发光法、免疫比浊法分别测定血清Hcy,NT-proBNP和血浆D-dimer水平。将三个变量指标组合建立logistic回归模型并绘制ROC曲线,通过曲线下面积、灵敏度、特异性等评价三项指标的诊断价值。结果急性脑梗死患者血清Hcy,NT-proBNP和血浆D-dimer水平均高于健康体检者,差异具有统计学意义(P <0. 001)。logistic回归-ROC曲线分析显示单项指标检测中D-dimer>415.87 ng/mL时,ROC曲线下面积为0.810,灵敏度为79.45%,特异性为84%,诊断价值高于Hcy和NT-proBNP。Hcy、NT-proBNP、D-dimer联合检测时,各组指标联合检测其曲线下面积均大于单一指标检测。D-dimer联合NT-proBNP检测为最理想组合,其ROC曲线下面积为0. 903,灵敏度为86%,特异性94%。结论 D-dimer联合NT-proBNP检测,具有较高的辅助诊断价值,有助于ACI的早期诊断。
Objective To explore the diagnostic value of the combined detection of serum Hcy,NT-proBNP and plasma D-dimer in acute cerebral infarction(ACI). Methods From September,2016 to September,2017,73 patients with acute cerebral infarction admitted to our department of neurology were selected as the experimental group. 50 healthy subjects in the same period were selected as the control group. The serum levels of Hcy,NT-proBNP and plasma D-dimer were measured by cyclic enzyme,chemiluminescence and immuno turbidimetry respectively among all patients. The three variables were combined to establish logistic regression model and further draw ROC curve. The diagnostic value of three indexes was evaluated by the area under the curve,sensitivity and specificity of the curve. Results The levels of serum Hcy,NT-proBNP and plasma D-dimer in patients with acute cerebral infarction were significantly higher than those in healthy person(P <0.001). Logistic regression-ROC curve analysis showed that the area under the ROC curve was0.810,and the sensitivity was 79.45%,the specificity was 84%. The diagnostic value was higher than that of Hcy and NT-proBNP when D-dimer >415.87 ng/mL was used in single index detection. For the combined detection of Hcy,NT-proBNP and D-dimer,each index joint detection area under the curve was higher than that of the single index detection. D-dimer combined with NT-proBNP was the best combination, in which the area under the ROC curve was 0. 903, the sensitivity 86. 3%, and the specificity 94%. Conclusion D-dimer combined with NT-proBNP detection has high diagnostic value, which is useful for the early diagnosis of ACI.
Objective To explore the diagnostic value of the combined detection of serum Hcy,NT-proBNP and plasma D-dimer in acute cerebral infarction(ACI). Methods From September,2016 to September,2017,73 patients with acute cerebral infarction admitted to our department of neurology were selected as the experimental group. 50 healthy subjects in the same period were selected as the control group. The serum levels of Hcy,NT-proBNP and plasma D-dimer were measured by cyclic enzyme,chemiluminescence and immuno turbidimetry respectively among all patients. The three variables were combined to establish logistic regression model and further draw ROC curve. The diagnostic value of three indexes was evaluated by the area under the curve,sensitivity and specificity of the curve. Results The levels of serum Hcy,NT-proBNP and plasma D-dimer in patients with acute cerebral infarction were significantly higher than those in healthy person(P <0.001). Logistic regression-ROC curve analysis showed that the area under the ROC curve was0.810,and the sensitivity was 79.45%,the specificity was 84%. The diagnostic value was higher than that of Hcy and NT-proBNP when D-dimer >415.87 ng/mL was used in single index detection. For the combined detection of Hcy,NT-proBNP and D-dimer,each index joint detection area under the curve was higher than that of the single index detection. D-dimer combined with NT-proBNP was the best combination, in which the area under the ROC curve was 0. 903, the sensitivity 86. 3%, and the specificity 94%. Conclusion D-dimer combined with NT-proBNP detection has high diagnostic value, which is useful for the early diagnosis of ACI.
引文
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[12]汪进丁,罗江洪,徐丽君,等. N端脑钠肽前体与急性脑梗死患者预后的相关性[J].中国神经精神疾病杂志,2014,40(11):646-651.
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[2]付云峰,熊燕,邓华菲,等.卡托普利抗同型半胱氨酸和溶血性磷脂酰胆碱损伤大鼠血管内皮功能[J].中国药理学与毒理学杂志,2003,17(3):179-183.
[3]陈华,周懿忆,戴屹东.NT-proBNP的临床应用进展[J].标记免疫分析与临床,2015,22(1):69-72.
[4]中华医学会全国第4届脑血管病学术会议制定诊断标准[J].中华神经科杂志,1996,29(6):378-380.
[5] SHENOY V, MEHENDALE V, PRABHUK, et al. Correlation of serum homocysteine levels with the severity of coronary artery disease[J]. Indian J Clin Biochem,2014,29(3):339-44.
[6]王春霞,张轶华.急性脑梗死患者血清同型半胱氨酸、尿酸及血脂水平的变化[J].检验医学,2015,30(3):303-304.
[7]董燕燕,陈光亮.高同型半胱氨酸血症危害及致病机制研究进展[J].中国药理学通报,2014,(9):1205-1208.
[8] ZI W J,SHUAI J. Plasma D-dimer levels are associated with stroke subtypes and infarction volume in patients with acute ischemic stroke[J]. PloS One,2014,9(1):e86465. doi:10. 1371/journal.pone. 0086465. eCollection 2014.
[9]谭渊志,熊炜,曾彪.联合同型半胱氨酸、C-反应蛋白、D-二聚体及纤维蛋白原检测在急性脑梗死中的意义[J].河北医药,2014,36(9):1326-1328.
[10] FOLSOM A R,NAMBI V, BELL E J,et al. Troponin T, NT-pro BNP, and Incidence of Stroke:The Atherosclerosis Risk in Communities(ARIC)Study[J]. Stroke,2013,44(4):961-967.
[11] GIANNAKOULAS G,HATZITOLIOS A,KARVOUNIS H,et al. Nterminal pro-brain natriuretic peptide levels are elevated in patients with acute ischemic stroke[J]. Angiology,2005,56(6):723-730.
[12]汪进丁,罗江洪,徐丽君,等. N端脑钠肽前体与急性脑梗死患者预后的相关性[J].中国神经精神疾病杂志,2014,40(11):646-651.
[13] MOLODIANOVITCH K,FARAGGI D, REISER B. Comparing the Areas Under Two Correlated ROC Curves:Parametric and NonParametric Approaches[J]. Biom J,2006,48(5):745-757.
[14] SWETS J A. Measuring the accuracy of diagnostic systems[J].science, 1988,240(4857):1285-1293.