Hcy、NT-proBNP、D-dimer联合检测对急性脑梗死诊断的应用价值  

The Diagnostic Value of the Combined Examination of Hcy,NT-proBNP and D-dimer in Patients with Acute Cerebral Infarction

作　　者：郝攀 HAO Pan(Department of Laboratory Medicine,Beijing Longfu Hospital,Beijing 100010,China)

机构地区：[1]北京市隆福医院检验科,北京100010

出　　处：《标记免疫分析与临床》2019年第2期212-215,233,共5页Labeled Immunoassays and Clinical Medicine

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 was 0.810,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.

关 键 词：急性脑梗死 同型半胱氨酸 N端前脑钠肽 D-二聚体 ROC曲线 LOGISTIC回归 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R446[医药卫生—临床医学]