血清cTnI、CK-MB、hs-CRP联合SAA与LDH1在重症哮喘患者并发心肌损伤的相关性分析
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摘要
目的探究血清肌钙蛋白Ⅰ(cTnI)、磷酸肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)联合血清淀粉样蛋白A(SAA)与乳酸脱氢酶同工酶1(LDH1)在重症哮喘患者并发心肌损伤的相关性。方法选取2013年3月至2016年9月期间入院就诊的重症哮喘患者76例,同期收取健康体检者74例。运用受试者工作特征曲线(ROC)技术分析血清cTnl、CK-MB、hs-CRP、SAA与LDH1在鉴别诊断重症哮喘患者并发心肌损伤的临床价值。相关性分析采用Spearman检验。多项Logistic回归分析计算(OR)及其95%置信区间(CI)。结果重症哮喘合并心肌损伤组患者血清SAA和LDH1水平显著高于未合并心肌损伤组和健康组,此外,未合并心肌损伤组患者血清SAA水平显著高于健康组,差异均有统计学意义(P均<0.05)。ROC曲线分析显示,血清SAA和LDH1区分重症哮喘合并心肌损伤者与重症哮喘未合并心肌损伤者的AUC分别为:0. 901 (95%CI:0. 840～0. 963,P <0.001)和0. 786 (95%CI:0. 702～0. 871,<0. 001);灵敏度和特异性分别为:80.2%、98. 9%和79. 1%、87. 4%;临界值分别为:94. 8mg/L和50.1U/L。当联合血清cTnI、SAA、LDH1、CK-MB和hs-CRP时,区分重症哮喘合并心肌损伤者与重症哮喘未合并心肌损伤者的AUC为0.952(95%CI:0. 904～0. 999,P <0.001),在"并联"时,约登指数为最大值时的灵敏度和特异性分别为93. 6%和86.4%;在"串联"时,约登指数为最大值时的灵敏度为69.7%,特异性为100.0%。结论血清cTnI、CK-MB、hs-CRP联合SAA与LDH1对重症哮喘合并心肌损伤具有潜在的诊断价值,有望为重症哮喘患者合并心肌损伤的诊疗提供新的途径与思路。
Objective To investigate the association of serum troponin I(cTnI), creatine phosphokinaseisoenzyme-MB( CK-MB), high-sensitivity C-reactive protein(hs-CRP) combined with serum amyloid A(SAA) and lactate Hydrogenase Isoenzyme 1(LDH1) in patients with severe asthma complicated with myocardial injury. Methods 76 severe asthmatic patients admitted to our hospital during the period from March 2013 to September 2016 were selected,and 74 healthy patients were collected during the same period.The clinical values of serum cTnI, CK-MB, hs-CRP, SAA, and LDHl in the diagnosis of severe asthmatic patients complicated with myocardial infarction were analyzed by using receiver operating characteristic curve(ROC)technique. Spearman test was used for the correlation analysis. Multiple logistic regression analysis(OR) and its 95% confidence interval(CI) were calculated. Results Serum SAA and LDH1 levels in patients with severe asthma complicated with myocardial injury were significantly higher than those in patients without myocardial injury and healthy controls. In addition, serum SAA levels in patients without myocardial injury were significantly higher than those in healthy controls, with statistically significant differences(P <0. 05).The ROC curve analysis showed that the AUC of serum SAA and LDH1 in distinguishing between severe asthma complicated with myocardial injury and severe asthma without myocardial injury were 0. 901(95%CI:0. 840-0.963,P <0. 001) and 0. 786(95% CI:0. 702-0. 871,P <0. 001). The sensitivity and specificity were 80.2%/98.9% and 79. 1%/87. 4%, respectively. The critical values were 94. 8 mg/L and 50.1 U/L,respectively. When combined with serum cTnI,SAA,LDHl,CK-MB,and hs-CRP,the AUC in distinguishing between severe asthma combined with myocardial injury and severe asthma without combined myocardial injury was 0. 952(95% CI:0. 904-0.999,P< 0. 001). In the "parallel",the sensitivity and specificity were93.6% and 86.4% respectively when the Youden index was maximal. In the "tandem",the sensitivity was69. 7% and the specificity was 100. 0. % when the Youden index was maximal. Conclusion Serum cTnI,CKMB, and hs-CRP combined with SAA and LDH1 have potential diagnostic value for severe asthma complicated with myocardial injury. It is expected to provide new ways and ideas for the diagnosis and treatment of myocardial injury in severe asthma patients.
Objective To investigate the association of serum troponin I(cTnI), creatine phosphokinaseisoenzyme-MB( CK-MB), high-sensitivity C-reactive protein(hs-CRP) combined with serum amyloid A(SAA) and lactate Hydrogenase Isoenzyme 1(LDH1) in patients with severe asthma complicated with myocardial injury. Methods 76 severe asthmatic patients admitted to our hospital during the period from March 2013 to September 2016 were selected,and 74 healthy patients were collected during the same period.The clinical values of serum cTnI, CK-MB, hs-CRP, SAA, and LDHl in the diagnosis of severe asthmatic patients complicated with myocardial infarction were analyzed by using receiver operating characteristic curve(ROC)technique. Spearman test was used for the correlation analysis. Multiple logistic regression analysis(OR) and its 95% confidence interval(CI) were calculated. Results Serum SAA and LDH1 levels in patients with severe asthma complicated with myocardial injury were significantly higher than those in patients without myocardial injury and healthy controls. In addition, serum SAA levels in patients without myocardial injury were significantly higher than those in healthy controls, with statistically significant differences(P <0. 05).The ROC curve analysis showed that the AUC of serum SAA and LDH1 in distinguishing between severe asthma complicated with myocardial injury and severe asthma without myocardial injury were 0. 901(95%CI:0. 840-0.963,P <0. 001) and 0. 786(95% CI:0. 702-0. 871,P <0. 001). The sensitivity and specificity were 80.2%/98.9% and 79. 1%/87. 4%, respectively. The critical values were 94. 8 mg/L and 50.1 U/L,respectively. When combined with serum cTnI,SAA,LDHl,CK-MB,and hs-CRP,the AUC in distinguishing between severe asthma combined with myocardial injury and severe asthma without combined myocardial injury was 0. 952(95% CI:0. 904-0.999,P< 0. 001). In the "parallel",the sensitivity and specificity were93.6% and 86.4% respectively when the Youden index was maximal. In the "tandem",the sensitivity was69. 7% and the specificity was 100. 0. % when the Youden index was maximal. Conclusion Serum cTnI,CKMB, and hs-CRP combined with SAA and LDH1 have potential diagnostic value for severe asthma complicated with myocardial injury. It is expected to provide new ways and ideas for the diagnosis and treatment of myocardial injury in severe asthma patients.
引文
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[12]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南(支气管哮喘的定义、诊断、治疗及教育和管理方案)[J].中华结核和呼吸杂志,2003,26(3):132-138.
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[14]胡海涛,曾丽娟,屈磊,等.噻托溴铵联合吸人糖皮质激素对哮喘-慢阻肺重叠综合征患者肺功能、FeNO及免疫功能的影响[J].空军医学杂志,2017,33(2):113-117.
[15]郑志方,陈国利,刘霞,等.血清淀粉样蛋白A、超敏C反应蛋白和降钙素原检测在儿童原发性肾病综合征中的应用价值及相关性分析[J].中国医学装备,2017,14(7):88-91.
[2]杨磊山,彭再梅.喘可治对哮喘急性发作进行急救治疗的有效性评价[J].空军医学杂志,2017,33(4):264-266.
[3]罗建江,马红霞.新疆维吾尔族哮喘患者β2-肾上腺素能受体基因多态性与地区及中医分型之间的关系研究[J].四川中医,2017,35(8):46-48.
[4]周文波.特布他林联合复方甲氧那明胶囊治疗咳嗽变异性哮喘的临床研究[J].现代药物与临床,2017,32(10):1881-1884.
[5]刘力坤,欧阳伟炜,苏胜发,等.DNA损伤及氧化应激在放射性心脏损伤中的作用[J].科技导报,2017,35(4):74-78.
[6]黄水英,李家富.髓过氧化物酶/对氧磷酶-1对高密度脂蛋白功能及冠心病危险评估的预测意义[J].当代医学,2017,23(7):182-184.
[7]叶张章,吴敏,梁毓源.原发性高血压患者胆红素及氧化应激水平与颈动脉粥样硬化的关系[J].中国循证心血管医学杂志,2017,9(9):1040-1044.
[8] UHDE M.AJAMIAN M,LI X,et al. Expression of C-reactive protein and serum amyloid A in early to late manifestations of lyme disease[J].Clin Infect Dis,2016,63(11):1399-1404.
[9] WATANABE K,UCHIDA K, CHAMBERS J K, et al. Deposition,clearance,and reinduction of amyloid A amyloid in interleukin 1receptor antagonist knockout mice[J]. Vet Pathol,2017,54(1):99-110.
[10]冷德文,柳梅,范学朋,等.传统心肌酶谱联合损伤相关蛋白IMA、TnⅠ-Ultra检测对急性心肌梗死早期诊断的价值分析[J].标记免疫分析与临床,2017,24(9):1033-1035,1067.
[11]彭建.黄芪珍珠母汤对病毒性心肌炎的临床疗效及血清心肌酶谱指标的影响[J].四川中医,2017,35(7):76-79.
[12]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南(支气管哮喘的定义、诊断、治疗及教育和管理方案)[J].中华结核和呼吸杂志,2003,26(3):132-138.
[13]于建秀,钱雷,陈国萍,等.哮喘患者外周血CD8~+CD25~+Foxp3~+Treg细胞检测及其临床意义[J].江苏大学学报(医学版),2017,27(6):483-487,517.
[14]胡海涛,曾丽娟,屈磊,等.噻托溴铵联合吸人糖皮质激素对哮喘-慢阻肺重叠综合征患者肺功能、FeNO及免疫功能的影响[J].空军医学杂志,2017,33(2):113-117.
[15]郑志方,陈国利,刘霞,等.血清淀粉样蛋白A、超敏C反应蛋白和降钙素原检测在儿童原发性肾病综合征中的应用价值及相关性分析[J].中国医学装备,2017,14(7):88-91.