摘要
目的 前瞻性研究动态心电图(DCG)联合血清缺血修饰白蛋白(IMA)、葡萄糖调节蛋白78(GRP78)、微小RNA-29a(miR-29a)诊断冠心病心肌缺血的临床价值.方法 回顾性选择2020年7月至2022年8月于宿迁市第一人民医院就诊的冠心病心肌缺血患者100例,按照冠脉病变支分为单支组(n=67)、多支组(n=33),两组均行DCG联合血清IMA、GRP78、miR-29a检查.观察两组DCG特征;血清IMA、GRP78、miR-29a水平.以冠脉造影诊断结果为金标准,评价DCG及血清IM A、GRP78、miR-29a单独、联合诊断冠心病心肌缺血的诊断效能.分析冠心病心肌缺血患者DCG特征及血清IMA、GRP78、miR-29a水平与冠心病心肌缺血的病变程度相关性.结果 单支组ST段压低幅度、ST段压低持续时间、心肌缺血发作频次分别为(1.41±0.16)mm、(7.82±0.80)min、(2.04±0.22)次、均小于多支组[(3.42±0.36)mm]、(17.13±1.93)min、(4.32±0.45)次],差异均有统计学意义(P＜0.05).单支组血清 IMA 水平为(13.29±1.60)U/mL,高于多支组[(7.34±0.76)U/mL],血清 GRP78、miR-29a 水平分别为(1.32±0.12)ng/mL、1.84±0.21,均低于单支组[(2.26±0.24)ng/mL、3.95±0.42],差异均有统计学意义(P＜0.05).以冠脉造影诊断结果为金标准,DCG及血清IMA、GRP78、miR-29a四者联合诊断冠心病心肌缺血的敏感度、特异度、阳性预测值及阴性预测值均高于四者单独、两两及三三联合诊断(P＜0.05).经Pearson相关性分析,ST段压低幅度、ST段压低持续时间、心肌缺血发作频次及血清GRP78、miR-29a水平与冠心病心肌缺血不同病变程度呈正相关(r=0.812、0.737、0.713、0.594、0.686,P＜0.05),血清IMA水平与冠心病心肌缺血不同病变程度呈负相关(r=-0.521,P＜0.05).结论 DCG联合血清IMA、GRP78、miR-29a可提高对冠心病心肌缺血的诊断效能.
Abstract
Objective To prospectively investigate the clinical value of Dynamic electrocardiogram(DCG)combined with serum Ischemia-modified albumin(IMA),Glucose-regulatory protein 78(GRP78)and micrnas 29a(miR-29a)in the diagnosis of myocardial ischemia in coronary heart disease.Methods A total of 100 patients with CHD-MI who were treated in Suqian First Hospital from July 2020 to August 2022 were selected and divided into the single branch group(n=67)and the multi-branch group(n=33)according to coronary artery lesion bran-ches.DCG combined with serum IMA,GRP78 and miR-29a were examined in both groups.The DCG characteristics of two groups were ob-served.Serum IMA,GRP78,miR-29a levels.The diagnostic efficacy of DCG and serum IMA,GRP78 and miR-29a in the diagnosis of myo-cardial ischemia in coronary heart disease alone or in combination was evaluated using the results of coronary angiography as the gold standard.The correlation between DCG characteristics and serum IMA,GRP78,miR-29a levels in myocardial ischemia in coronary heart disease patients and the degree of CHD-MI lesions was analyzed.Results The ST segment depression amplitude,ST segment depression duration and frequency of myocardial ischemic attack in the single brach group were(1.41±0.16)mm,(7.82±0.80)min,(2.04±0.22)times,which were lower than those in the multi-brach group[(3.42±0.36)mm,(17.13±1.93)min,(4.32±0.45)times],the differences were statistically sig-nificant(P＜0.05).The level of serum IMA in the single brach group was(13.29±1.60)U/mL,which was higher than that in the multi-brach group[(7.34±0.76)U/mL],the levels of serum GRP78 and miR-29a were(1.32±0.12)ng/mL,1.84±0.21,which were lower than those in the single brach group[(2.26±0.24)ng/mL,3.95±0.42],the differences were statistically significant(P＜0.05).The sen-sitivity,specificity,positive predictive value and negative predictive value of DCG combined with IMA,GRP78 and miR-29a in the diagnosis of myocardial ischemia in coronary heart disease were higher than those of DCG combined with IMA,GRP78 and Mir-29A alone using the results of coronary angiography as the gold standard(P＜0.05).Pearson correlation analysis showed that ST segment depression amplitude,ST segment depression duration,frequency of myocardial ischemic attack and serum GRP78 and miR-29a levels were positively correlated with different de-grees of myocardial ischemia in coronary heart disease lesions(r=0.812,0.737,0.713,0.594,0.686,P＜0.05).Serum IMA level was negatively correlated with CHD-MI lesion degree(r=-0.521,P＜0.05).Conclusion DCG combined with IMA,GRP78 and miR-29a can improve the diagnostic efficiency of myocardial ischemia in coronary heart disease.
维普
万方数据