24 h动态心电图联合血清H-FABP、CysC、BNP水平检测对老年冠心病心肌缺血的诊断价值  

Value of 24 h dynamic electrocardiogram combined with serum H-FABP,CysC,and BNP levels in diagnosing myocardial ischaemia in coronary heart disease in the elderly

作　　者：李媛媛 袁先琢 汪俊秋 吴美雪 胡青林[3] 诸波[4] LI Yuanyuan;YUAN Xianzhuo;WANG Junqiu;WU Meixue;HU Qinglin;ZHU Bo(Electrocardiogram Room,Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine,Chuzhou 239000,Anhui,China;Department of Cardiovascular Medicine,Chuzhou Hospital of Integrated Chinese and Western Medicine,Chuzhou 239000,Anhui,China;Department of Urology Surgery,Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine,Chuzhou 239000,Anhui,China;Department of Clinical Laboratory,Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine,Chuzhou 239000,Anhui,China)

机构地区：[1]滁州市中西医结合医院心电图室,安徽滁州239000 [2]滁州市中西医结合医院心血管内科,安徽滁州239000 [3]滁州市中西医结合医院泌尿外科,安徽滁州239000 [4]滁州市中西医结合医院检验科,安徽滁州239000

出　　处：《贵州医科大学学报》2025年第2期294-299,共6页Journal of Guizhou Medical University

基　　金：安徽省中医药管理局项目(皖中医药秘[2024]6)。

摘　　要：目的探讨24 h动态心电图联合血清心型脂肪酸结合蛋白(heart-type fatty acid-binding protein,H-FABP)、血清胱抑素C(serum cystatin C,CysC)、脑钠肽(brain natriuretic peptide,BNP)水平检测在老年冠心病心肌缺血的诊断价值。方法选取124例疑似老年冠心病(coronary heart disease,CHD)心肌缺血患者,根据冠状动脉造影(coronary angiography,CAG)技术对CHD诊断标准的结果分为CAG阳性组(n=51)和CAG阴性组(n=73);建立多因素logistic回归模型,分析影响CHD心肌缺血的影响因素;采用受检者工作特征曲线(ROC)下面积(AUC)评估患者24 h动态心电图,监测心肌缺血发作持续时间,联合血清H-FABP、CysC、BNP检测对CHD心肌缺血的诊断价值。结果与CAG阴性组比较,CAG阳性组患者血清H-FABP、CysC、BNP、心肌缺血发作持续时间显著升高,P均=0.001;经多因素logistic回归分析,结果显示高血压史、H-FABP、CysC、BNP、24 h动态心电图监测的心肌缺血发作持续时间均是CHD心肌缺血患者的独立影响因素(P<0.05);经ROC曲线结果显示,H-FABP、CysC、BNP、心肌缺血发作持续时间及联合检测诊断CHD心肌缺血的AUC分别为0.808、0.674、0.783、0.807、0.951。结论24 h动态心电图检测心肌缺血发作持续时间联合血清H-FABP、CysC、BNP水平能够显著提高对冠心病心肌缺血的诊断价值。Objective To investigate the value of 24 h dynamic electrocardiogram combined with serum heart-type fatty acid-binding protein(H-FABP),serum cystatin C(CysC),and brain natriuretic peptide(BNP)levels in diagnosing myocardial ischemia in coronary heart disease(CHD)in the elderly.Methods A total of 124 elderly patients with suspected CHD myocardial ischemia were collected.According to the results diagnosed by coronary angiography(CAG),these patients were assigned to CAG-positive group(n=51)and CAG-negative group(n=73).Multivariate Logistic regression model was established to analyze the influencing factors of myocardial ischemia in CHD.Area under the receiver operating characteristic curve(ROC,AUC)was used to evaluate the diagnostic values of 24 h dynamic electrocardiogram of the patients,monitored duration of myocardial ischemic attack and combined serum H-FABP,CysC,BNP for CHD myocardial ischemia.Results When compared to CAG-negative group,serum H-FABP,CysC,BNP,and the duration of myocardial ischemic attack were significantly increased in CAG-positive group(P=0.001).Multivariate logistic regression analysis showed that the history of hypertension,H-FABP,CysC,BNP and the duration of myocardial ischemic attack were independent factors of the patients with CHD myocardial ischemia(P<0.05).ROC curve results showed that area under curves(AUC s)of H-FABP,CysC,BNP,the duration of myocardial ischemic attack and combined detection for CHD myocardial ischemia were 0.808,0.674,0.783,0.807,and 0.951,respectively.Conclusion 24 h dynamic electrocardiography-detected duration of myocardial ischaemic episodes in combination with serum H-FABP,CysC,and BNP levels can significantly improve the diagnostic value of myocardial ischaemia in coronary heart disease.

关 键 词：老年冠心病 心肌缺血 24 h动态心电图 血清胱抑素C 脑钠肽 

分 类 号：R541.4[医药卫生—心血管疾病]