Application of lipoprotein a, fibrinogen and C-reactive protein in early diagnosis of coronary heart disease
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摘要:
目的 探讨分析血清脂蛋白a(Lpa)、血浆纤维蛋白原(FIB)和C反应蛋白(CRP)三者检测指标在冠心病(CHD)诊断中的意义。 方法 选取2020年3月—2021年5月在蚌埠医科大学第一附属医院就诊的43例CHD患者作为CHD组，选择同一时段在该院就诊行冠状动脉造影结果正常的45例健康志愿者作为对照组，比较2组临床资料。分别应用免疫比浊法、凝固法和免疫透射比浊方法检测CHD组及对照组研究对象血浆中的Lpa、FIB与CRP水平并进行比较。通过ROC曲线分析各指标单独诊断及三者联合诊断CHD的诊断价值及最佳阈值。 结果 CHD组Lpa、FIB与CRP水平均高于对照组(P < 0.05)。血清Lpa、FIB、CRP单独检测诊断CHD的AUC分别为0.771(95% CI：0.674~0.868)、0.749(95% CI: 0.640~0.859)、0.791(95% CI: 0.697~0.886)，灵敏度分别为53.13%、50.00%、59.38%，特异度分别为81.08%、78.39%、78.29%；三者联合检测诊断CHD的AUC为0.884(95% CI: 0.813~0.956)，灵敏度为81.25%，特异度为78.29%，血清Lpa、FIB、CRP三者联合检测诊断CHD优于单独检测。 结论 Lpa、FIB与CRP联合检测可提高CHD诊断的灵敏度，有利于CHD患者的早期发现，从而采取积极有效措施以干预CHD疾病的发展。 Abstract:Objective To investigate the application value of serum lipoprotein a (Lpa), plasma fibrinogen (FIB) and C-reactive protein (CRP) levels in the diagnosis of coronary heart disease (CHD). Methods Forty-three patients with CHD who received medical treatment in the First Affiliated Hospital of Bengbu Medical University from March 2020 to May 2021 were selected as the experimental group, and 45 healthy volunteers who received normal coronary angiography results in the same hospital during the same period were selected as the control group. Volunteers served as the control group. The clinical data of the two groups were compared. The plasma levels of Lpa, FIB and CRP were measured using the immunoturbidimetric method, coagulation method and immunoturbidimetric method, respectively, and a comparison of their levels was made between the CHD group and the control group. The optimal threshold for CHD diagnosis was determined by analyzing the individual diagnostic value of each indicator and the combined diagnostic value of the three through the ROC curve analysis. Results The levels of Lpa, FIB and CRP in the CHD group were higher than those in the control group (P < 0.05). The AUC of serum Lpa, FIB, and CRP for diagnosing CHD were 0.771 (95% CI: 0.674-0.868), 0.749 (95% CI: 0.640-0.859), and 0.791 (95% CI: 0.697-0.886), respectively, with sensitivities of 53.13%, 50.00%, 59.38% and specificities of 81.08%, 78.39%, 78.29%. The combined detection of the three to diagnose CHD area had an AUC of 0.884 (95% CI: 0.813-0.956), a sensitivity of 81.25%, and a specificity of 78.29%. The combined detection of serum Lpa, FIB, and CRP was better than individual detection. Conclusion The combined detection of Lpa, FIB and CRP can improve the sensitivity of CHD diagnosis and facilitate the early detection, thereby enabling proactive intervention to mitigate the development of the disease. -
Key words:
- Coronary heart disease /
- Lipoprotein a /
- Fibrinogen /
- C-reactive protein /
- ROC curve
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图 1 Lpa、FIB与CRP单独及三者联合诊断CHD的ROC曲线
Figure 1. ROC curve analysis of Lpa, FIB and CRP alone and combination for the diagnosis of CHD
表 1 CHD组与对照组一般资料比较
Table 1. Comparison of general information between CHD group and control group
组别 例数 年龄(x±s, 岁) 性别[例(%)] 男性 女性 CHD组 43 60.51±3.38 24(55.81) 19(44.19) 对照组 45 59.47±4.76 24(53.33) 21(46.67) 统计量 1.186a 0.055b P值 0.236 0.815 注：a为t值，b为χ2值。 
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表 2 CHD组与对照组Lpa、FIB及CRP水平比较(x±s)
Table 2. Comparison of Lpa, FIB, and CRP between CHD group and control group(x±s)
组别 例数 Lpa(mg/L) FIB(g/L) CRP(mg/L) CHD组 43 328.41±40.67 3.54±0.69 12.69±3.50 对照组 45 253.31±59.16 2.82±0.47 7.93±2.98 t值 6.965 5.695 6.878 P值 <0.001 <0.001 <0.001
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表 3 Lpa、FIB与CRP单独及三者联合诊断CHD的效能分析
Table 3. Efficacy analysis of Lpa, FIB and CRP alone and combination for the diagnosis of CHD
项目 AUC 95% CI 灵敏度(%) 特异度(%) 准确度(%) 阳性预测值(%) 阴性预测值(%) 约登指数 Lpa 0.771a 0.674~0.868 53.13 81.08 68.12 70.83 66.67 0.342 FIB 0.749a 0.640~0.859 50.00 78.39 65.22 66.67 64.44 0.284 CRP 0.791a 0.697~0.886 59.38 78.29 76.81 86.36 72.34 0.377 联合诊断 0.884 0.813~0.956 81.25 78.29 79.72 76.48 87.89 0.595 注：与联合诊断比较，aP<0.05。
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