PCT联合NLR检测在急性心肌梗死中的诊断价值分析  

Diagnostic value of PCT combined with NLR in acute myocardial infarction

作　　者：冯月平 刘国杰 袁炜华 罗满亮 FENG Yue-ping;LIU Guo-jie;YUAN Wei-hua(YunFu People's Hospital,Yunfu 527300,China)

机构地区：[1]云浮市人民医院,527300

出　　处：《中国实用医药》2022年第16期6-10,共5页China Practical Medicine

基　　金：云浮市科学技术局医药卫生类科研项目(项目编号:WS202008)。

摘　　要：目的探讨降钙素原(PCT)联合中性粒细胞与淋巴细胞比值(NLR)检测对急性心肌梗死(AMI)的诊断价值。方法选取42例确诊为AMI患者作为AMI组,另选取同期伴胸痛、胸闷等疑似急性冠状动脉综合征(ACS)的非冠心病住院患者42例作为对照组。两组均进行血常规、肌酸激酶同工酶(CK-MB)、超敏肌钙蛋白I(hs-cTnI)、PCT检测,绘制受试者工作特征(ROC)曲线,计算出PCT、NLR及其联合检测对诊断AMI的敏感度和特异度;通过与AMI的经典诊断指标CK-MB和hs-cTnI的ROC曲线下面积(AUC)的比较,构建出更好的检测模型。比较两组PCT、NLR、白细胞计数(WBC)、中性粒细胞绝对值(NEUT#)及淋巴细胞绝对值(LYMPH#),PCT、NLR、CK-MB及hs-cTnI单独检测和运用Logstic回归模型对AMI的诊断价值。结果AMI组的PCT、NLR、WBC和NEUT#均显著高于对照组,差异具有统计学意义(P<0.05);AMI组的LYMPH#低于对照组,但差异无统计学意义(P=0.813>0.05)。Logistic回归分析显示,PCT、NLR、WBC和NEUT#是AMI的独立危险因素(P<0.05)。PCT对AMI的诊断敏感度为76.2%,特异度为85.7%,以AMI(AMI组、对照组)为状态变量绘制ROC曲线,AUC为0.878;NLR对AMI的诊断敏感度为81.0%,特异度为57.1%,AUC为0.709。PCT和NLR的AUC均>70%,对AMI有较好的诊断价值(P<0.01)。将PCT、NLR组合成联合检测谱,得到AUC为0.898,大于单一检测,与NLR比较差异有统计学意义(P<0.01),与PCT比较差异无统计学意义(P=0.3029>0.05)。经Logistic单因素分析,PCT、NLR、CK-MB及hs-cTnI均为对诊断AMI有意义的变量(P<0.05),以AMI状态(AMI组和对照组)为因变量,PCT和NLR检测结果为自变量,采用Logistic二元回归分析得到综合预测概率变量PRE-1;以PCT、NLR和CK-MB检测结果为自变量,采用Logistic二元回归分析得到综合预测概率变量PRE-2。以PRE-1和PRE-2为自变量,以AMI状态(AMI组和对照组)为因变量绘制ROC曲线。单一及联合指标检测的AUC比较:hs-cTnI>PRE-2>PRE-1>CK-MB>PCT>NLR。PCObjective To discuss the diagnostic value of procalcitonin(PCT)combined with neutrophilto-lymphocyte ratio(NLR)in acute myocardial infarction.Methods 42 patients with confirmed AMI were selected as the AMI group,and another 42 non-coronary inpatients with suspected acute coronary syndrome(ACS)such as chest pain and chest tightness during the same period were selected as the control group.Routine blood tests,creatine kinase isoenzyme(CK-MB),high-sensitivity cardiac troponin I(hs-cTnI),and PCT were performed in both groups.The sensitivity and specificity of PCT,NLR and their combined detection for AMI were calculated by drawing receiver operator characteristic(ROC)curve.A better detection model was constructed by comparing the area under the ROC curve(AUC)with the classical diagnostic indexes of AMI(CK-MB and hs-cTnI).Comparison was made on PCT,NLR,white blood cell count(WBC),neutrophil absolute value(NEUT#)and lymphocyte absolute value(LYMPH#)between the two groups,as well as diagnostic value of PCT,NLR,CK-MB and hs-cTnI alone and using Logstic regression model for AMI.Results The PCT,NLR,WBC and NEUT#in the AMI group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).The LYMPH#of the AMI group was lower than that of the control group,but the difference was not statistically significant(P=0.813>0.05).Logistic regression analysis showed that PCT,NLR,WBC and NEUT#were independent risk factors for AMI(P<0.05).The diagnostic sensitivity of PCT for AMI was 76.2%,and the specificity was 85.7%.The ROC curve was drawn with AMI(AMI group,control group)as the state variable,and the AUC was 0.878;the diagnostic sensitivity of NLR for AMI was 81.0%,and the specificity was 57.1%,and the AUC was 0.709.The AUC of PCT and NLR were both>70%,which had good diagnostic value for AMI(P<0.01).The AUC of the combined detection of PCT and NLR was 0.898,which was greater than that of the single detection,and the difference was statistically significant compared with NLR(P<0.0

关 键 词：降钙素原 中性粒细胞与淋巴细胞比值 急性心肌梗死 白细胞计数 曲线下面积 

分 类 号：R542.22[医药卫生—心血管疾病]