血清碱性磷酸酶及白蛋白水平对冠脉慢血流的预测作用

目的 探讨血清碱性磷酸酶（ALP）及白蛋白水平对冠脉慢血流现象（CSFP）的预测价值。方法 收集2015年 1月—2018年 5月在我院心内科住院行冠脉造影的患者共 3 163例，根据心肌梗死溶栓治疗（TIMI）血流分级法，将 TIMI血流 2级或 2级以下且冠脉无明显狭窄者 73例作为 CSFP组，TIMI血流 3级且冠脉无明显狭窄者 108例作为对照组，收集血常规、生化等指标，比较 2组一般临床资料，采用二分类 Logistic回归分析 CSFP的危险因素，绘制ROC曲线分析血清中 ALP、白蛋白预测 CSFP的临床价值。结果 CSFP组男性比例、吸烟比例和尿酸（UA）、ALP水平均升高，白蛋白水平降低（P＜0.05）。Logistic回归分析显示，男性、吸烟、高 ALP及 UA水平是 CSFP的独立危险因素，白蛋白水平升高是 CSFP的保护性因素（P＜0.05）。血清白蛋白、ALP诊断 CSFP的 ROC曲线下面积分别为 0.824（95%CI：0.764~0.885）、0.637（95%CI：0.554~0.721）。ALP的最佳诊断界值为 74.71 U/L，敏感度 58%，特异度 69%；白蛋白的最佳诊断界值为 46.35 g/L，敏感度 74%，特异度 82%，血清白蛋白诊断 CSFP 的约登指数（0.56）大于 ALP（0.27）。结论 血清白蛋白、ALP均有预测 CSFP的价值，血清白蛋白的诊断效能优于 ALP，两者均为廉价且易获得的指标，可能成为 CSFP的预测因子。

The predictive effect of serum alkaline phosphatase and albumin levels on slow coronary blood flow

Objective To explore the predictive value of serum alkaline phosphatase (ALP) and albumin levels on coronary slow flow phenomenon (CSFP). Methods A total of 3 163 patients with coronary angiography in the Department of Cardiology of our hospital were collected from January 2015 to May 2018. According to the blood flow classification method of thrombolysis in myocardial infarction (TIMI), 73 patients with TIMI blood flow grade 2 or below and no obvious coronary stenosis were taken as the CSFP group, 108 patients with TIMI blood flow grade 3 and no obvious coronary stenosis were used as the control group. The risk factors of CSFP were analyzed by binary Logistic regression and ROC curve was drawn to analyze the clinical value of serum ALP and albumin in predicting CSFP. Results In the CSFP group, the male proportion,smoking proportion, uric acid (UA) and ALP levels were all increased, while the albumin level was decreased (P＜0.05).Binary Logistic regression analysis showed that male, smoking, high ALP and UA levels were independent risk factors of CSFP, and the albumin level was protective factor of CSFP (P＜0.05). The area under ROC curves of serum albumin and ALP were 0.824 (95%CI: 0.764-0.885) and 0.637 (95%CI: 0.554-0.721) respectively. The best diagnostic threshold value of ALP was 74.71 U/L, the sensitivity 58% and the specificity 69%. The best diagnostic threshold value of albumin was 46.35 g/L,the sensitivity 74% and the specificity 82%. The Yoden index of serum albumin (0.56) in the diagnosis of CSFP was higher than that of ALP (0.27). Conclusion The serum levels of albumin and ALP have the value of predicting CSFP, and the diagnostic efficiency of serum albumin is better than that of ALP. Both of them are cheap and easy to obtain indicators, which can be used as effective predictors of CSFP.