基于Logistic回归和ROC曲线综合评价IMA,NLR,hs-CRP和CK-MB联合检测对早期急性心肌梗死的诊断价值

目的 采用Logistic回归和受试者特征曲线(ROC)方法评价缺血修饰清蛋白(IMA)、中性粒细胞淋巴细胞比率(NLR)、超敏C反应蛋白(hs-CRP)以及肌酸激酶同工酶(CK-MB)单项及联合检测对急性心肌梗死(AMI)的早期诊断价值。方法 检测胸痛发生后3 h内和3～6 h内95例AMI患者血清IMA,hs-CRP,CK-MB和cTnI以及全血NLR水平,并与60例来自体检中心的人群(作为阴性对照)做比较。应用Logistic回归模型,绘制ROC曲线,计算曲线下面积(AUC)评价各指标的诊断价值。结果①胸痛0～3 h AMI组IMA,NLR,hs-CRP,CK-MB和cTnI的平均值分别为96.04U/L,3.77,13.39mg/L,43.26U/L和0.063 ng/ml,均高于对照组的78.10 U/L,2.02,3.12 mg/L,19.37 U/L和0.040 ng/ml,差异有统计学意义(P均<0.01)。胸痛3～6 h AMI组IMA,NLR,hs-CRP,CK-MB和cTnI指标均高于0～3 h AMI组,差异有统计学意义(P均<0.05)。②胸痛0～3 h AMI组IMA,NLR,hs-CRP和CK-MB 4项联合诊断早期AMI的ROC AUC为0.98,高于各指标单项检测的AUC(分别为0.89,0.83,0.79和0.85)。同时,4项联合检测对早期AMI诊断价值也显著高于心梗诊断的经典血清学指标cTnI(AUC=0.78)。结论 IMA,NLR,hs-CRP和CK-MB联合检测有助于提高早期AMI的诊断效能,优于各单项目检测。

Comprehensive Evaluation of the Diagnostic Value of the Combined Detection of IMA,NLR,hs-CRP and CK-MB for Acute Myocardial Infarction Based on ROC Curve and Logistic Regression Analysis

Objective To assess the diagnostic value of IMA,NLR,hs-CRP and CK-MB individually and the combined detection for early acute myocardial infarction using ROC curve and Logistic regression.Methods To detect levels of IMA,NLR,hs-CRP,CK-MB and cTnI in serumor whole blood of AMI patients that had chest pain within 3 hours or between 3 and 6 hours,compared with 60 healthy people from Physical Examination Center.Applied Logistic regression,plotted ROC curve and calculated the area under ROC curve(AUC)to assess the diagnostic value of each index.Results The serum IMA,hs-CRP,CK-MB and cTnI or whole blood NLR levels of AMIpatients with 3 hours were remarkably higher than normal control,showing significant statistical difference(P<0.01)(AMI group:mean values of IMA,NLR,hs-CRP,CK-MB and cTnI were 96.04 U/L,3.77,13.39 mg/L,43.26 U/L and 0.063 ng/ml; normal control group:mean values of IMA,NLR,hs-CRP,CK-MB and cTnI were 78.10 U/L,2.02,3.12 mg/L,19.37 U/L and 0.040 ng/ml.The serum IMA,NLR,hs-CRP,CK-MB and cTnI levels of AMI patients in the group between 3～6hours were higher than in the group within 3 hours(P<0.05).The AUC of combined detection of IMA,NLR,hs-CRP and CK-MB for early AMI was 0.98,higherthan solo detection of IMA,NLR,hs-CRP and CK-MB,which were 0.89,0.83,0.79 and 0.85 respectively.Meanwhile,the AUC of combined detection for four markers also surpassed that of cTnI alone that was recognized as a classic serological marker to diagnose AMI(AUC=0.78).Conclusion The combined detection of IMA,NLR,hs-CRP and CK-MB is superior to a single index detection,which can significantly improve diagnostic efficiency for early AMI.