标题：冠心病患者血清NCAM-1、NT-proBNP和cTnI浓度及其诊断价值

      作者：曾伟雄，曾金财，方快发    惠州市第六人民医院心内科，广东 惠州 516200

      卷次： 2020年31卷23期

      【摘要】 目的 检测冠心病患者的神经细胞黏附分子-1 (NCAM-1)、氨基末端B型钠尿肽原(NT-proBNP)和肌钙蛋白 I (cTnI)浓度，并探讨其临床诊断价值。方法 将惠州市第六人民医院2019年1~6月诊治的67例冠心病患者纳入冠心病组，同期年龄和性别匹配的健康志愿者 70例作为对照组。冠心病组又分为急性心肌梗死(AMI)组、不稳定型心绞痛(UAP)组和稳定型心绞痛(SAP)组。所有受检者采用ELISA法检测血清NCAM-1浓度，免疫荧光法检测NT-proBNP和 cTnI浓度。采用受试者工作曲线(ROC)分析NCAM-1、NT-proBNP和 cTnI对冠心病的诊断价值。结果 冠心病组患者的血清NCAM-1浓度明显低于对照组，而血清NT-pro BNP和 cTnI浓度明显高于对照组，差异均有统计学意义(P<0.05)；AMI组、UAP组和SAP组患者的血清NCAM-1浓度依次升高，而NT-proBNP和 cTnI浓度依次降低，差异均有统计学意义(P<0.05)。患者的血清NCAM-1浓度随心功能分级增高而降低，而血清NT-proBNP和 cTnI浓度随心功能分级增高而增高，差异均有统计学意义(P<0.05)，当截断值为133.43 ng/mL时，血清NCAM-1浓度诊断冠心病的ROC曲线下面积(AUC)为 0.953 (95%CI 0.919~0.977，P=0.000 8)，敏感性和特异性分别为 89.9%和 97.5%；当截断值为 321.00 ng/L时，血清NT-proBNP诊断冠心病的AUC为 0.941 (95%CI 0.932~0.960，P=0.001 7)，敏感性和特异性分别为85.1%和97.0%；当截断值为0.205 μg/L时，血清cTnI诊断冠心病的AUC为0.855 (95%CI 0.792~0.919，P=0.001 3)，敏感性和特异性分别为65.5%和97.5%。结论 血清NCAM-1、NT-proBNP和cTnI均可作为冠心病的诊断指标，NCAM-1对冠心病诊断价值高，其可能为冠心病潜在血清标志物。
      【关键词】 冠心病；神经细胞黏附分子-1；氨基末端B型钠尿肽原；肌钙蛋白 I；受试者工作曲线；诊断价值
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2020）23—3013—04

Concentration of NCAM-1, NT-proBNP, and cTnI in patients with coronary heart disease and their diagnosticvalue.
ZENG Wei-xiong, ZENG Jin-cai, FANG Kuai-fa. Department of Cardiology, the Sixth People's Hospital of Huizhou,Huizhou 516200, Guangdong, CHINA
【Abstract】 Objective To investigate the concentration of neural cell adhesion molecule-1 (NCAM-1), aminoterminal B-type natriuretic peptide (NT-proBNP), and cardiac troponin I (cTnI) in patients with coronary heart diseaseand analyze their clinical diagnostic value. Methods Sixty-seven coronary heart disease patients, who admitted to theSixth People's Hospital of Huizhou from Jan. to June 2019, were enrolled as coronary heart disease group. Seventyhealthy subjects who had matched age and gender were recruited in the healthy control group. Coronary heart diseasegroup included acute myocardial infarction (AMI) group, unstable angina pectoris (UAP) group, and stable angina pec-toris (SAP) group. Serum NCAM-1 concentration were measured by ELISA. Serum NT-proBNP and cTnI concentra-tions were detected by time-resolved fluorescence immunoassay (TRFIA). The receiver operating characteristic (ROC)curve was used to analyze the diagnosis values of NCAM-1, NT-proBNP, and cTnI for coronary heart disease patients.Results Serum NCAM-1 concentrations were significantly lower in coronary heart disease group than in healthy con-trol group, while the concentration of NT-proBNP and cTnI in coronary heart disease group was significantly higherthan that in healthy control group (P<0.05). The serum NCAM-1 concentrations in AMI group, UAP group and SAPgroup were increased in turn, the concentration of NT-proBNP and cTnI in AMI subgroup, UAP subgroup and SAP sub-group decreased in turn, with statistically significant differences (all P<0.05). The serum concentration of NCAM-1 de-creased with the increase of functional grade, while the concentration of NT-proBNP and cTnI increased with the in-crease of functional grade (P<0.05). When the cut-off value was 133.43 ng/mL, the area under the ROC curve (AUC) ofserum NACM-1 was 0.953 (95%CI 0.919-0.977, P=0.000 8), and the sensitivity and specificity were 89.9% and 97.5%respectively. When the cut-off value was 321.00 ng/L, the area under the ROC curve (AUC) of serum NT-proBNP was0.941 (95%CI 0.932-0.960, P=0.001 7), and the sensitivity and specificity were 85.1% and 97.0%, respectively. Whenthe cut-off value was 0.205 μg/L, the area under the ROC curve (AUC) of serum cTnI was 0.855 (95%CI 0.792-0.919,P=0.001 3), and the sensitivity and specificity were 65.5% and 97.5% respectively. Conclusion Serum NCAM-1,NT-proBNP, and cTnI can be used as diagnostic indicators of coronary heart disease. NCAM-1 has high diagnostic val-ue for coronary heart disease, which may be a potential serum marker of coronary heart disease.
      【Key words】 Coronary heart disease; Neural cell adhesion molecule-1 (NCAM-1); Amino terminal B-type natri-uretic peptide (NT-proBNP); Cardiac tropon