24 h动态心电图联合血清BNP、MPO、IMA在诊断老年冠心病合并无症状心肌缺血中的价值分析  

Analysis of value of 24-h dynamic electrocardiogram combined with serum BNP,MPO,and IMA in diagnosing elderly coronary heart disease complicated with silent myocardial ischemia

作　　者：水应兰 陈众 常青 Shui Yinglan;Chen Zhong;Chang Qing(Department of Clinical Laboratory,Luoyang Branch of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,Luoyang,Henan 471000,China)

机构地区：[1]北京中医药大学东直门医院洛阳医院检验科,河南洛阳471000

出　　处：《齐齐哈尔医学院学报》2025年第4期364-368,共5页Journal of Qiqihar Medical University

基　　金：河南省医学科技攻关计划(LHGJ20220491)。

摘　　要：目的 探讨24 h动态心电图联合血清BNP、MPO、IMA在诊断老年冠心病(Coronary Heart Disease, CHD)合并无症状心肌缺血(Silent Myocardial Ischemia, SMI)中的价值。方法 选择2023年1月—2024年1月本院收治的疑似CHD合并SMI的337例老年患者作为研究对象,以冠状动脉造影(Coronary Angiography, CAG)检查结果为金标准,将其分为阳性组(n=215例)和阴性组(n=122例)两组,对所以患者行24 h动态心电图检测分析其相关参数[24 h QT间期变异性(24 h QTV)、24 h连续5 min正常R-R间期标准差(Standard Deviation of All Normal to Normal RR Intervals Averaged for All 5-Minute Segments of a 24-Hour Period,SDANN-index)以及24 h连续5 min正常R-R间期标准差均值(Standard Deviation of NN Intervals, SDNN)],并对其血清BNP、MPO、IMA水平进行检测,采用受试者工作特征曲线(ROC)分析24 h动态心电图相关参数联合血清BNP、MPO、IMA水平预测老年CHD合并SMI的诊断效能。结果 阳性组患者24 h动态心电图相关参数指标均明显低于阴性组(P<0.05);阳性组患者血清BNP、MPO以及IMA水平均明显高于阴性组(P<0.05);Logistic回归分析结果显示,BNP、MPO以及IMA为老年CHD并发SMI的危险因素,24 h QTV是其保护因素(均P<0.05);绘制ROC曲线结果显示,24 h QTV、BNP、IMA以及MPO水平诊断老年CHD并发SMI的AUC值分别为0.719、0.904、0.915以及0.895,而联合检查的AUC值为0.991;阳性组ST段压低共发生236阵次,阴性组ST段压低共发生749阵次,其发作时间主要集中在06︰01~12︰00,两组发作时间分布比较无差异(Z=5.958,P=0.114)。结论 24 h动态心电图联合BNP、MPO以及IMA指标对老年CHD合并SMI具有较高的诊断价值,能有效鉴别其性质,可作为CHD合并SMI的诊断指标,且联合检测不仅提高了诊断的准确性,还降低了误诊和漏诊率,从而避免了不必要的医疗资源浪费;此外,早期诊断和及时干预能够显著改善患者的生活质量,减少并发症的发生,进一步降低了Objective To investigate the value of 24-hour Holter monitoring combined with serum BNP,MPO,and IMA in diagnosing coronary heart disease(CHD)combined with silent myocardial ischemia(SMI)in elderly patients.Methods A total of 337 elderly patients with suspected CHD combined with SMI admitted from January 2023 to January 2024 were selected as research subjects.The results of coronary angiography(CAG)served as the gold standard,dividing patients into a positive group(n=215)and a negative group(n=122).24-hour Holter monitoring was performed on all patients to analyze relevant parameters[24-hour QT interval variability(24 hQTV),standard deviation of all normal to normal RR intervals averaged for all 5-minute segments of a 24-hour period(SDANN-index),and standard deviation of NN intervals(SDNN)].Serum levels of BNP,MPO,and IMA were also tested.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic performance of 24-hour Holter monitoring parameters combined with serum BNP,MPO,and IMA levels in predicting CHD combined with SMI in elderly patients.Results The 24-hour dynamic electrocardiogram parameters in the positive group were significantly lower than those in the negative group(P<0.05).Serum levels of BNP,MPO,and IMA in the positive group were significantly higher than those in the negative group(P<0.05).Logistic regression analysis showed that BNP,MPO,and IMA were risk factors for SMI in elderly patients with CHD,while 24hQTV was a protective factor(all P<0.05).The ROC curve analysis showed that the AUC values for diagnosing SMI in elderly patients with CHD were 0.719 for 24hQTV,0.904 for BNP,0.915 for IMA,and 0.895 for MPO,while the AUC value for the combined examination was 0.991.There were 236 occurrences of ST segment depression in the positive group and 749 in the negative group,with the occurrence time mainly concentrated between 06︰01-12︰00,and no difference in the distribution of occurrence time between the two groups(Z=5.958,P=0.114).Conclusions The combination of 24-ho

关 键 词：24 h动态心电图 BNP MPO IMA 冠心病 SMI 诊断价值 

分 类 号：R541.4[医药卫生—心血管疾病]