心肌梗死老年患者血浆Hcy、D-二聚体水平与早期诊断及分期的相关性分析
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摘要
目的:分析老年心肌梗死(MI)患者血浆同型半胱氨酸(Hcy)、D-二聚体(D-D)水平对早期诊断及分期的价值及其相关性。方法:以本院2014年1月～2016年6月收治的92例老年MI患者纳入MI组,同期92例老年健康者作为健康对照组。检测比较两组血浆Hcy、D-D水平,分析Hcy、D-D及二者联合检测对MI的诊断及分期的诊断意义。根据临床分期,MI组被进一步分为急性期组(46例)和非急性期组(46例),检测比较两组Hcy、D-D、心肌肌钙蛋白I(cTnI)和cTnT水平,分析Hcy、D-D水平与MI发生、分期、cTnT及cTnI水平的相关性。结果:与健康对照组比较,MI组血浆Hcy[(8.76±2.59)μmol/L比(22.72±10.21)μmol/L]和D-D[(229.59±31.60)μg/L比(1057.88±250.74)μg/L]水平均显著升高,P均=0.001。Hcy、D-D以及二者联合检测诊断MI的准确性分别为90.76%、84.78%和94.02%。与非急性期组比较,急性期组血浆Hcy、D-D、cTnT和cTnI水平均显著升高,P均=0.001。相关分析显示,血浆Hcy、D-D水平与MI发生、cTnT和cTnI水平呈显著正相关(r=0.875～0.951),与MI分期呈显著负相关(r=-0.870,-0.914),P均=0.001。结论:Hcy、D-D水平检测对于心肌梗死的早期诊断、临床分期均具有较高的参考价值,可在临床中推广应用。
Objective: To analyze value of plasma levels of homocysteine(Hcy)and D-dimer(D-D)for early diagnosis and staging in aged patients with myocardial infarction(MI) and their correlation. Methods:A total of 92 aged MI patients treated in our hospital from Jan 2014 to Jun 2016 were enrolled in MI group. Another 92 healthy aged people were simultaneously regarded as healthy control group. Plasma Hcy and D-D levels were measured and compared between two groups. Diagnostic value of Hcy, D-D and their combination for MI were analyzed. According to clinical staging, MI group was further divided into acute stage group(n=46) and non-acute stage group(n=46). Levels of Hcy, D-D, cardiac troponin I(cTnI) and cTnT were measured and compared between two groups, and correlation among Hcy, D-D levels and occurrence and staging of MI, cTnT and cTnI levels were analyzed. Results:Compared with healthy control group, there were significant rise in plasma levels of Hcy[(8.76±2.59)μmol/L vs.(22.72±10.21)μmol/L]and D-D[(229.59±31.60)μg/L vs.(1057.88±250.74)μg/L]in MI group, P=0.001 both. Accuracies of Hcy, D-D and Hcy+D-D diagnosing MI were 90.76%, 84.78% and 94.02% respectively. Compared with non-acute stage group, there were significant rise in plasma levels of Hcy, D-D, cTnT and cTnI in acute stage group, P=0.001 all. Correlation analysis indicated that plasma levels of Hcy and D-D were significant positively correlated with MI occurrence, cTnT and cTnI levels(r=0.875-0.951), and significant inversely correlated with MI staging(r=-0.870,-0.914), P=0.001 all. Conclusion:Hcy and D-D level detections possess high accuracy for early diagnosis and clinical staging of MI.It can be extended and applied in clinic.
Objective: To analyze value of plasma levels of homocysteine(Hcy)and D-dimer(D-D)for early diagnosis and staging in aged patients with myocardial infarction(MI) and their correlation. Methods:A total of 92 aged MI patients treated in our hospital from Jan 2014 to Jun 2016 were enrolled in MI group. Another 92 healthy aged people were simultaneously regarded as healthy control group. Plasma Hcy and D-D levels were measured and compared between two groups. Diagnostic value of Hcy, D-D and their combination for MI were analyzed. According to clinical staging, MI group was further divided into acute stage group(n=46) and non-acute stage group(n=46). Levels of Hcy, D-D, cardiac troponin I(cTnI) and cTnT were measured and compared between two groups, and correlation among Hcy, D-D levels and occurrence and staging of MI, cTnT and cTnI levels were analyzed. Results:Compared with healthy control group, there were significant rise in plasma levels of Hcy[(8.76±2.59)μmol/L vs.(22.72±10.21)μmol/L]and D-D[(229.59±31.60)μg/L vs.(1057.88±250.74)μg/L]in MI group, P=0.001 both. Accuracies of Hcy, D-D and Hcy+D-D diagnosing MI were 90.76%, 84.78% and 94.02% respectively. Compared with non-acute stage group, there were significant rise in plasma levels of Hcy, D-D, cTnT and cTnI in acute stage group, P=0.001 all. Correlation analysis indicated that plasma levels of Hcy and D-D were significant positively correlated with MI occurrence, cTnT and cTnI levels(r=0.875-0.951), and significant inversely correlated with MI staging(r=-0.870,-0.914), P=0.001 all. Conclusion:Hcy and D-D level detections possess high accuracy for early diagnosis and clinical staging of MI.It can be extended and applied in clinic.
引文
[1]蔚楠.Hcy,ET-1,D-二聚体在急性心肌梗死溶栓治疗前后的检测意义[J].实验与检验医学,2016,34(4):493-494.
[2]周芸华,徐勤燕,潘秋荣.血HCY、ET-1、BNP及D-二聚体检测对急性脑梗死诊断的临床应用价值[J].国际检验医学杂志,2013,34(21):2846-2847,2849.
[3]华星,王甲文,荆成宝,等.血清Hcy与C反应蛋白对心血管类疾病诊治及预后判断的价值[J].海南医学院学报,2016,22(3):237-239,242.
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[5]杨俊,王冠,吴晓芬,等.床旁联合检测NT-proBNP、cTnT、D-二聚体在心血管急症早期诊断中的价值[J].中国动脉硬化杂志,2015,23(1):64-68.
[6]王光.血清同型半胱氨酸在心血管疾病检测中的临床应用[J].中国乡村医药,2013,20(2):61-62.
[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,中国循环杂志编辑委员会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[8]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[9]童铎,胡家庆,胡彬,等.急性心肌梗死患者血清同型半胱氨酸水平变化的分析[J].中华全科医学,2016,14(3):506-508.
[10]邓超蓝.BNP、hsCRP及D-D水平对诊断急性心肌梗死的临床意义[J].华南国防医学杂志,2014,28(8):822-823.
[11]宗华.血清同型半胱氨酸检测在心血管疾病中的临床运用分析[J].现代诊断与治疗,2013,24(19):4536.
[12]周挥信,邓泽洪.急性心梗患者溶栓治疗前后血清Hcy、IL-6和ET-1表达及意义[J].医学临床研究,2013,30(3):540-541,544.
[13]刘世平,徐彤彤.急性心肌梗死患者早期干预血清Hcy水平的变化及意义[J].中国现代医生,2015,53(27):5-7.
[14]徐颖,钱申.血浆D-二聚体测定在深静脉血栓形成中的意义[J].浙江医学,2013,35(22):1985-1988.
[15]李广华,龚彩平,叶联珍,等.血浆D二聚体水平在心血管疾病中应用价值的探讨[J].血栓与止血学,2014,20(1):29-32.
[16]陈晓芳.冠心病患者血中同型半胱氨酸血脂及D-二聚体的实验分析[J].山西医药杂志,2015,44(9):1072-1073.
[2]周芸华,徐勤燕,潘秋荣.血HCY、ET-1、BNP及D-二聚体检测对急性脑梗死诊断的临床应用价值[J].国际检验医学杂志,2013,34(21):2846-2847,2849.
[3]华星,王甲文,荆成宝,等.血清Hcy与C反应蛋白对心血管类疾病诊治及预后判断的价值[J].海南医学院学报,2016,22(3):237-239,242.
[4]王锦霞,杨西爱.血清同型半胱氨酸检测在心脑血管疾病中的运用[J].河北医学,2014,20(1):123-125.
[5]杨俊,王冠,吴晓芬,等.床旁联合检测NT-proBNP、cTnT、D-二聚体在心血管急症早期诊断中的价值[J].中国动脉硬化杂志,2015,23(1):64-68.
[6]王光.血清同型半胱氨酸在心血管疾病检测中的临床应用[J].中国乡村医药,2013,20(2):61-62.
[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,中国循环杂志编辑委员会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[8]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[9]童铎,胡家庆,胡彬,等.急性心肌梗死患者血清同型半胱氨酸水平变化的分析[J].中华全科医学,2016,14(3):506-508.
[10]邓超蓝.BNP、hsCRP及D-D水平对诊断急性心肌梗死的临床意义[J].华南国防医学杂志,2014,28(8):822-823.
[11]宗华.血清同型半胱氨酸检测在心血管疾病中的临床运用分析[J].现代诊断与治疗,2013,24(19):4536.
[12]周挥信,邓泽洪.急性心梗患者溶栓治疗前后血清Hcy、IL-6和ET-1表达及意义[J].医学临床研究,2013,30(3):540-541,544.
[13]刘世平,徐彤彤.急性心肌梗死患者早期干预血清Hcy水平的变化及意义[J].中国现代医生,2015,53(27):5-7.
[14]徐颖,钱申.血浆D-二聚体测定在深静脉血栓形成中的意义[J].浙江医学,2013,35(22):1985-1988.
[15]李广华,龚彩平,叶联珍,等.血浆D二聚体水平在心血管疾病中应用价值的探讨[J].血栓与止血学,2014,20(1):29-32.
[16]陈晓芳.冠心病患者血中同型半胱氨酸血脂及D-二聚体的实验分析[J].山西医药杂志,2015,44(9):1072-1073.