胱抑素C联合颈动脉斑块评分提高胸痛者严重冠心病的预测能力  

Cystatin C combined with carotid artery plaque score improves predictability of significant coronary artery disease in patients with chest pain

作　　者：吴晓妍[1] 缪绯[1] 王秋实[1] 刘芃[1] 吴宏超[1] 刘映峰[1] 张琰[1] 

机构地区：[1]南方医科大学珠江医院心血管内科,广州市510280

出　　处：《实用医学杂志》2017年第11期1765-1769,共5页The Journal of Practical Medicine

基　　金：广东省自然科学基金(编号:2015A030313238);广东省科技计划项目(编号:2014A020223044)

摘　　要：目的:利用血浆胱抑素C浓度(Cyst-C)、颈动脉斑块评分(PS)预测胸痛患者严重冠心病(SCAD)的存在。方法:按入选标准回顾性收集192例胸痛患者,根据冠脉造影结果分为SCAD组(共128例)和非严重冠心病(NSCAD)组(共64例),统计分析Cyst-C与PS同SCAD的关系及对其预测能力。结果:Logistic回归分析提示Cyst-C、PS是SCAD的独立预测因子,Cyst-C每增加1 mg/L,PS每增加1 mm,其优势比(OR)分别是1.329与1.197。受试者工作(ROC)曲线分析提示以Cyst-C、PS预测SCAD的曲线下面积(AUC)分别是0.654与0.688,联合两者可提高AUC至0.742,与Cyst-C及PS单项的AUC相比,差异均有统计学意义(P值分别是0.046,0.004)。Cyst-C、PS的最佳截断点分别是0.95 mg/L、3 mm,其对SCAD预测的敏感性分别是72.3%,70.7%;阴性预测值分别是46.3%,48.3%;联合两者,敏感性与阴性预测值均增高(分别是83.6%,62.5%)。结论:Cyst-C及PS与SCAD相关,均是胸痛者SCAD的独立预测因子,联合两者能提高预测能力,增加心导管术前筛查SCAD的可靠性。Objective To assess the value of plasma level of cystatin C （Cyst-C） and carotid artery plaque score （PS） in predicting significant coronary artery disease （SCAD） in patients with chest pain. Methods A total of 192 patients with chest pain were involved retrospectively. According to the coronary angiography results, the patients were divided into groups of SCAD （n = 128） and non-significant coronary artery disease （NSCAD, n = 64）. Analyses were done to discuss the association of Cyst-C and PS with SCAD and the predictive value of Cyst-C and PS for SCAD. Results Logistic regression analysis demonstrated that Cyst-C and PS were independent predictors of SCAD. The odds ratios （ OR ） associated with the Cyst-C （ each 1 mg/L ） and PS （ each 1 mm） for prediction of SCAD were 1.329 and 1.197, respectively. The areas under the receiver-operating characteristic curves （AUC） for the Cyst-C and the PS to predict the SCAD were 0.654 and 0.688, respectively. The combination of Cyst-C and PS increased the AUC to 0.742. The optimal cut-off value of Cyst-C was 0.95 mg/L and had a sensitivity of 72.3% for SCAD. Similarly, the optimal cut-off level of PS was 3ram which presented a sensitivity of 70.7%. A Cyst-C ≥ 0.95 mg/L and a PS ≥ 3 mm had negative predictive values of 46.3% and 48.3% , respectively, for SCAD. By combining Cyst-C with PS, the sensitivity and negative predictive value increased to 83.6% and 62.5%, respectively. Conclusions Cyst-C and PS are both correlated with SCAD. They are independent predictive factors for SCAD in patients with chest pain. Combination of Cyst-C and PS can improve the predictability, which may increase the reliability of screening SCAD before cardiac catheterization.

关 键 词：胱抑素C 颈动脉斑块评分 胸痛 严重冠心病 ROC曲线 

分 类 号：R541.4[医药卫生—心血管疾病]