多重标志物联合检测模型在诊断4a型急性心肌梗死中的应用  

Clinical application of multi-marker combined detection model in diagnosing type 4a myocardial infarction

作　　者：吴雨洁[1] 邓博 郭明全 王珏 何烨 孟浩宇[1] 王连生[1] WU Yujie;DENG Bo;GUO Mingquan;WANG Jue;HE Ye;MENG Haoyu;WANG Liansheng(Department of Cardiology,Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital,Nanjing 210029,Jiangsu;Key Laboratory of Precision and Intelligent Chemistry,Department of Chemistry,University of Science and Technology of China)

机构地区：[1]南京医科大学第一附属医院心血管内科,南京210029 [2]中国科学技术大学化学系精准智能化学重点实验室,合肥230026

出　　处：《临床检验杂志》2024年第8期574-579,共6页Chinese Journal of Clinical Laboratory Science

基　　金：南京医科大学第一附属医院临床能力提升工程(JPH511-2022-2)。

摘　　要：目的与单一标志物高敏肌钙蛋白T(cTnT)进行对比,初步探索多重心肌标志物[和肽素(copeptin)、cTnT和心脏型脂肪酸结合蛋白(HFABP)]联合检测模型在诊断4a型急性心肌梗死(AMI)中的应用价值。方法纳入2022年3月至12月期间在南京医科大学第一附属医院接受择期经皮冠状动脉介入治疗(PCI)且术后cTnT升高超过正常参考值上限(URL)第99百分位数的非AMI患者。根据《第四版心肌梗死通用定义》,按照术后是否出现4a型AMI将患者分为非4a型AMI组和4a型AMI组。采用化学发光免疫金纳米组装体免疫传感阵列(ciGold)测定AMI生物标志物浓度。通过受试者工作特征(ROC)曲线分析单一标志物和多重联合心肌标志物诊断模型的诊断性能,从ROC曲线获得敏感性和特异性,计算ROC曲线下面积(AUCROC)评估各自诊断价值。使用Kappa分析评估多重标志物联合检测模型与《第四版心肌梗死通用定义》诊断的一致性。结果共纳入65例患者,女性占23.1%。ROC曲线分析显示,多重联合心肌标志物诊断模型的特异性为96.5%,敏感性为92.3%,符合率为94.6%,阳性预测值为92.3%,阴性预测值为96.2%,AUCROC为0.979。cTnT模型的特异性为94.2%,敏感性为100%,符合率为95.7%,阳性预测值为100%,阴性预测值为94.9%,AUCROC为0.987。虽然多重标志物联合检测模型诊断敏感性较低(P=0.011),但具有更高的特异性(P=0.016)。两种诊断模型准确性的AUCROC差异性分析提示P>0.05,诊断准确性无明显统计学差异。Kappa分析结果表明,多重联合心肌标志物检测模型与《第四版心肌梗死通用定义》诊断4a型AMI具有高度一致性,Cohen′s Kappa系数为0.818。结论多重标志物联合检测模型与cTnT在诊断4a型AMI方面性能相近,诊断一致性高,但联合检测模型具有更高的特异性优势。Objective To compare the diagnostic performance of a multi-marker panel(copeptin,cardiac troponin T[cTnT],and heart-type fatty acid-binding protein[HFABP])with the single marker cTnT in the diagnosis of type 4a acute myocardial infarction(AMI),and explore the application value of combined detectionmodel with the multiple markers.Methods The enrolled non-AMI patients underwent elective percutaneous coronary intervention(PCI)at Nanjing Medical University First Affiliated Hospital during the period from March to December 2022 and were assessed as postoperative elevation of cTnT above the 99th percentile upper reference limit(URL).According to the Fourth Universal Definition of Myocardial Infarction,the patients were divided into non-type 4a AMI group and type 4a AMI group based on whether type 4a AMI occurred after surgery.The concentrations of AMI biomarkers were measured using a chemiluminescent immuno-gold nanoassembly immunosensor array(chemiluminescent immuno-Gold,ciGold).Receiver operating characteristic(ROC)curves were used to analyze the performance of the diagnostic models with single and combined cardiac biomarkers.The sensitivity and specificity were also obtained from the ROC curves,and the area under the ROC curve(AUC~(ROC))was calculated to evaluate respective diagnostic value.Kappa analysis was used to assess the consistency between the results combined detection model of multiple biomarkers and the diagnosis based on the Fourth Universal Definition of Myocardial Infarction.Results In this study,a total of 65 patients were included in whom females accounted for 23.1%.The ROC curve indicated that the combined detection model of multiple cardiac biomarkers showed specificity of 96.5%,sensitivity of 92.3%,agreement rate of 94.6%,positive predictive value of 92.3%,negative predictive value of 96.2%,and AUC~(ROC)of 0.979.The single cTnT diagnostic model showed specificity of 94.2%,sensitivity of 100%,agreement rate of 95.7%,positive predictive value of 100%,negative predictive value of 94.9%,and AUC~(ROC)o

关 键 词：4a型心肌梗死 和肽素 心脏型脂肪酸结合蛋白 肌钙蛋白T 多重标志物联合检测模型 

分 类 号：R446[医药卫生—诊断学]