基于hs-CRP、HMGB1及Myo的急性冠脉综合征诊断预测模型构建

Establishment of predictive model for acute coronary syndrome based on Hs-CRP, HMGB1 and Myo

摘要:

目的 探讨急性冠脉综合征(acute coronary syndromes, ACS)患者不同心肌标志物水平变化以及联合多种心肌志记物对ACS的预测作用。方法 选取ACS患者100例，对照组89例，分别检测血清中血脂常规生化指标；心肌损伤标志物包括肌酸激酶同工酶(Creatine kinase isoenzyme, CK-MB)、肌钙蛋白T(troponin T, TnT)、肌红蛋白(myoglobin, Myo)、超敏肌钙蛋白T(hypersensitive troponin, hs-TnT)、脑钠肽(brain natriuretic peptide, BNP)；炎症因子包括高迁移率族蛋白1(high mobility group box-1 protein, HMGB1)、超敏C反应蛋白(high sensitive C-reactive protein, hs-CRP)；白细胞(white blood cell, WBC)；中性粒细胞百分比以及空腹血糖水平，并比较两组之间的差异。结果 ACS组患者血清中BNP、CK-MB、TnT、Myo、hs-CRP、hs-TnT、以及HMGB1水平均高于对照组(P<0.05)；hs-CRP、HMGB1联合Myo构建模型对ACS测试集数据进行诊断预测，阴性预测率为81.82%，阳性预测率为95.24%，AUC为0.9063；hs-CRP、HMGB1与CK-MB为ACS发生的危险因素，OR分别为1.95(95%CI： 1.32~2.55)、7.44(95%CI： 6.51~8.14)与3.51(95%CI： 2.33~4.59)；Myo为ACS发生的保护因素，OR为0.17(95%CI： 0.10~0.35)。结论 血清hs-CRP、HMGB1与Myo构建预测模型有助于对ACS患者的早期诊断。

Abstract:

Objective To establish a predictive model for acute coronary syndrome(ACS) based on Hs-CRP, HMGB1 and Myo. Methods One hundred ACS patients(ACS group) and 89 healthy subjects(control group) were enrolled in the study. Blood lipids(TC, TG, HDL and LDL), myocardial injury markers(CK-MB, TnT, Myo, hs-TnT and BNP), inflammatory factors(HMGB1 and hs-CRP), polymorphic particles and fasting blood glucose levels were measured and compared between two groups. Logistic regression was used to establish a predictive model for ACS. Results The CK-MB, TnT, Myo, hs-TnT, HMGB1, BNP and hs-CRP levels in ACS group were significantly higher than those in control group(P<0.05). Logistic regression analysis showed that hs-CRP, HMGB1 and CK-MB were the risk factors for ACS(OR=1.95,95%CI: 1.322.55; OR=7.44,95%CI: 6.518.14; OR=3.51,95%CI: 2.334.59), and Myo was the protective factor of ACS(OR=0.17,95%CI: 0.100.35). A predictive model was established based on hs-CRP, HMGB1 and Myo. The area under curve(AUC) of the model was 0.9063, and the positive predictive value and the negative predictive value were 95.24% and 81.82%, respectively. Conclusion Serum hs-CRP, HMGB1 and Myo are of value in early diagnosis of patients with acute coronary syndrome.