标题:脓毒症心肌缺血患者 IMA、CK-MB、cTnT水平的变化及临床意义
作者:李朝辉,梁燕媚,胡雅,廖梅嫣,黄志伟,黄伟建,叶健翔 肇庆市第二人民医院检验科,广东 肇庆 526060
卷次:
2021年32卷13期
【摘要】 目的 探讨脓毒症心肌缺血患者缺血修饰白蛋白(IMA)、肌酸激酶同工酶(CK-MB)以及心肌肌钙蛋白T (cTnT)水平的变化及其临床意义。方法 选择2019年5月至2020年10月期间肇庆市第二人民医院收治的60例脓毒症患者设为观察组,另选取同时间段内本院60例健康体检者设为对照组,均行 IMA、CK-MB及 cTnT检测,比较两组受检者的 IMA、CK-MB及cTnT水平。依据观察组患者是否出现心血管事件分为事件组15例与非事件组45例,比较两组患者的 IMA、CK-MB及 cTnT水平。应用ROC曲线测定 IMA诊断脓毒症患者心肌缺血的最佳Cut-off值,确定 IMA对脓毒症心肌缺血的诊断敏感度、特异度与阳性预测值及阴性预测值。结果 观察组患者的IMA、CK-MB及 cTnT水平分别为(68.25±20.34) U/mL、(45.68±9.45) U/L、(28.35±2.65) pg/mL,明显高于对照组的(10.38±3.26) U/mL、(10.62±2.76 ) U/L、(11.82±1.38) pg/mL,差异均有统计学意义(P<0.05);事件组患者的 IMA、CK-MB及 cTnT水平分别为 (86.25±20.42) U/mL、(65.75±9.62) U/L、(48.32±3.65) pg/mL,明显高于非事件组的(69.30±19.58) U/mL、(45.42±2.38) U/L、(28.40±2.59) pg/mL,差异均有统计学意义(P<0.05);结合ROC曲线,发现Cut-off值在 64.5 U/mL最佳,此时 IMA检测敏感度、特异度、阳性预测值以及阴性预测值均较高,依次是 82.61%、88.00%、86.36%、84.62%。结论 脓毒症心肌缺血患者的 IMA、CK-MB、cTnI明显增高,IMA对脓毒症心肌缺血的诊断具有较高的临床价值。
【关键词】 脓毒症;心肌缺血;缺血修饰白蛋白;肌酸激酶同工酶;心肌肌钙蛋白T;心血管事件
【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350(2021)13—1659—03
Changes and clinical significance of ischemia modified albumin, CK-MB, and cTnT in sepsis patients withmyocardial ischemia and the diagnostic value of ischemia modified albumin.
LI Chao-hui, LIANG Yan-mei, HU Ya,LIAO Mei-yan, HUANG Zhi-wei, HUANG Wei-jian, YE Jian-xiang. Department of Laboratory, the Second People'sHospital of Zhaoqing, Zhaoqing 526060, Guangdong, CHINA
【Abstract】 Objective To analyze the changes of ischemia modified albumin (IMA), creatine kinase-MB isoen-zyme (CK-MB), and cardiac troponin T (cTnT) in sepsis patients with myocardial ischemia and the diagnostic value ofIMA. Methods Sixty sepsis patients in the Second People's Hospital of Zhaoqing from May 2019 to October 2020were selected as observation group, and 60 healthy physical examination subjects were selected as control group in thesame time period. IMA and CK-MB, cTnT were tested in all the patients. The levels of IMA and CK-MB in both groupswere statistically compared. According to whether cardiovascular events occurred in the observation group, the twogroups were divided into two groups: the event group and the non-event group. The levels of IMA, CK-MB, cTnT inboth groups were compared. ROC curve was applied to determine the best cut off value of IMA in the diagnosis of myo-cardial ischemia in patients with sepsis. The sensitivity, specificity, positive and negative predictive values of IMA to sep-sis myocardial ischemia were determined. Results The levels of IMA, CK-MB, and cTnT in the observation group were(68.25±20.34) U/mL, (45.68±9.45) U/L, (28.35±2.65) pg/mL, which were significantly higher than (10.38±3.26) U/mL,(10.62±2.76) U/L, (11.82±1.38) pg/mL in the control group (P<0.05). The levels of IMA, CK-MB, cTnT in event groupwere (86.25 ± 20.42) U/mL, (65.75 ± 9.62) U/L, (48.32 ± 3.65) pg/mL, significantly higher than (69.30 ± 19.58) U/mL,(45.42±2.38) U/L, (28.40±2.59) pg/mL in non-event group (P<0.05). Combined with ROC curve, it was found that thebest cut off value was 64.5 U/mL, and the sensitivity, specificity, positive and negative predictive values of IMA were rel-atively high, which were 82.61% , 88.00% , 86.36% , and 84.62% respectively. Conclusion IMA, CK-MB and cTnIwere significantly increased in sepsis patients with myocardial ischemia, and IMA is of great value in the diagnosis ofmyocardial ischemia in sepsis.
【Key words】 Sepsis; Myocardial ischemia; Ischemia modified albumin; Creatine kinase isoenzyme; Cardiac tro-ponin T; Cardiovascular events
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