血清总唾液酸、唾液酸酶和超敏C反应蛋白联合检测对急性心肌梗死患者诊断和预后评估的临床价值

目的：探讨联合检测血清总唾液酸(TSA)、唾液酸酶(NEU)及超敏C反应蛋白(hs-CRP)在急性心肌梗死(AMI)患者的诊断和预后评估中的临床价值。方法收集2015年8~12月武汉大学人民医院的AMI患者210例(病例组)及同期体检健康者99例(对照组)，其中病例组患者根据AMI类型分为ST段抬高型AMI组(STEMI组)和非ST段抬高型AMI组(NSTEMI组)；根据AMI部位，分为前壁梗死组和下壁梗死组；根据是否院内死亡，分为院内死亡组和存活组。分别检测各组受检者的血清TSA、NEU、hs-CRP的浓度，并对其结果进行统计学分析。结果病例组患者的血清TSA水平为717 mg/L，明显高于对照组的568 mg/L，差异有统计学意义(U=2346.5，P<0.01)，血清NEU水平为16.69 ng/mL，明显高于对照组的13.32 ng/mL，差异有统计学意义(U=5465.0，P<0.01)，血清hs-CRP水平为14.34 mg/dL，明显高于对照组的0.35 mg/dL，差异有统计学意义(U=458.0，P<0.01)；STEMI组和NSTEMI组之间各指标差异无统计学意义(P>0.05)；前壁梗死组患者的血清TSA水平为746 mg/L，明显高于下壁梗死组的648 mg/L，血清hs-CRP水平为19.63 mg/dL，明显高于下壁梗死组的7.80 mg/dL，差异均有统计学意义（U=2302.5、2169.5，P均<0.01)；院内死亡组的TSA水平为948 mg/L，明显高于存活组的697 mg/L，hs-CRP水平为58.37 mg/mL，明显高于存活组的11.00 mg/mL，差异均有统计学意义(U=1006.5、1052.0，P均<0.01)；AMI患者血清TSA与hs-CRP呈显著负相关(r=0.623，P<0.01)；绘制受试者工作特征曲线后显示，用血清TSA诊断AMI时，曲线下面积为86.0%(P<0.01)，用血清hs-CRP诊断AMI时，曲线下面积为97.3%(P<0.01)，联合血清TSA和hs-CRP诊断AMI时，曲线下面积为97.4%(P<0.01)。结论联合检测血清TSA、NEU和hs-CRP对于AMI患者的诊断和预后评估都具有重要意义。

Clinical value of combined detection of serum total sialic acid,sialidase and high sensitivity C-reactive protein in patients with acute myocardial infarction

Objective To evaluate the clinical value of combined detection of serum total sialic acid (TSA), neuramidinase (NEU) and high sensitivity C-reactive protein (hs-CRP) in the diagnosis and prognosis evaluation of acute myocardial infarction (AMI). Methods Ninety-nine healthy subjects (control group) and 210 AMI patients (case group) who visited the Renmin Hospital of Wuhan University from August to December 2015 were selected as the study subjects. According to AMI type, the case group was divided into ST segment elevation type AMI group (STEMI group) and non ST segment elevation type AMI group (NSTEMI group). According to AMI site, the patients were divided into anterior wall infarction group and inferior wall infarction group. According to whether the hospital death occurred, the case group was divided into the hospital death group and survival group. The levels of serum TSA, NEU and hs-CRP were detected and then compared between groups. Results Compared with the control group, the levels of TSA, NEU, and hs-CRP in case group were significantly increased [717 (612~834) mg/L vs 568 (534~605) mg/L, U=2 346.5, P<0.01;16.69 ng/mL vs 13.32 ng/mL, U=5 465.0, P<0.01;14.34 mg/dL vs 0.35 mg/dL, U=458.0, P<0.01]. There was no sta-tistically significant difference in the levels of TSA, NEU, and hs-CRP between STEMI group and NSTEMI group. Com-pared with the inferior wall infarction group, the serum TSA level and hs-CRP level in the anterior wall infarction group were significantly increased (746 mg/L vs 648 mg/L, U=2 302.5, P<0.01;19.63 mg/dL vs 7.80 mg/dL, U=2 169.5, P<0.01). Compared with the survival group, the level of serum TSA and hs-CRP in the hospital death group were significantly in-creased (948 mg/L vs 697 mg/L, U=1 006.5, P<0.01;58.37 mg/mL vs 11.00 mg/mL, U=1 052.0, P<0.01). Spearman cor-relation analysis showed that serum TSA and hs-CRP levels were significantly positively correlated (r=0.623, P<0.01) in AMI patients. After drawing the receiver operating characteristic curve, the area under the curve was 86.0% (P<0.01) when the serum TSA was used for the diagnosis of AMI, and the area under the curve was 97.3%(P<0.01) when the se-rum hs-CRP was used for the diagnosis of AMI. The area under the curve was 97.4%(P<0.01) when combined serum TSA and hs-CRP was used in the diagnosis of AMI. Conclusion The combined detection of serum TSA, NEU and hs-CRP has a certain clinical value for the diagnosis and prognosis evaluation of AMI.