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目的定量分析冠心病(CHD)患者血尿酸(UA)、胆红素(TBIL)及同型半胱氨酸(Hcy)的临床应用价值。方法收集285名对照者和721例CHD患者,将721例CHD患者分为稳定型心绞痛(SAP)、不稳定型心绞痛(UAP)、Q波心肌梗死(QMI)和非Q波心梗(NQMI)4组,测定285名对照者和721例CHD患者的UA、TBIL及Hcy,应用方差分析和受试者特性(ROC)曲线对不同类型CHD组内、CHD组与对照组之间进行比较与分析。结果①不同类型CHD与对照组相比:各组UA均显著高于对照组(P<0.01);除SAP外,TBIL均显著低于对照组(P<0.01);QMI和NQMI组Hcy显著高于对照组(P<0.01);CHD组Hcy、UA均显著高于对照组(P<0.01);CHD组TBIL显著低于对照组(P<0.01)。不同类型CHD组内比较:TBIL各组间差异无统计学意义(P>0.05)。与SAP组比较:UAP组、QMI和NQMI组,Hcy显著高于SAP组(P<0.01)。与NQMI组相比:QMI组UA和UAP组Hcy差异有统计学意义(P<0.05);SAP组Hcy差异有统计学意义(P<0.01)。②冠心病各组TBIL、UA、Hcy各指标诊断灵敏度偏低,特异性相对较高。TBIL对冠心病诊断的灵敏度31.2%,特异性80%,阳性和阴性似然比分别为1.56、0.86。Hcy对SAP的诊断灵敏度50%,特异性82%,阳性似然比2.78,阴性似然比0.61。UA对CHD的诊断评价指标都较低。③不同类型CHD及CHD组的TBIL面积均大于0.5;Hcy面积除SAP组为0.641外,其他组均小于0.5;UA面积均小于0.5。结论TBIL、UA、Hcy与CHD的发生、发展密切相关,对CHD的临床诊断价值均较低,可能会成为实验室诊断CHD的筛查指标。
Objective To quantitatively analyze the clinical value of serum uric acid (UA), bilirubin (TBIL) and homocysteine (Hcy) in patients with coronary heart disease (CHD). Methods A total of 285 controls and 721 CHD patients were enrolled in this study. 721 CHD patients were divided into stable angina pectoris (SAP), unstable angina pectoris (UAP), Q wave myocardial infarction (QMI) and non Q wave myocardial infarction (NQMI) 4 groups. The UA, TBIL and Hcy in 285 controls and 721 CHD patients were determined. The ANOVA and ROC curves were used to compare and analyze the CHD group and the control group . Results ① Compared with the control group, the levels of UA in all the groups were significantly higher than those in the control group (P <0.01), while the levels of TBIL in SAP group were significantly lower than those in the control group (P <0.01); Hcy was significantly higher in the QMI and NQMI groups (P <0.01). The levels of Hcy and UA in CHD group were significantly higher than those in control group (P <0.01). TBIL in CHD group was significantly lower than that in control group (P <0.01). Different types of CHD group comparison: TBIL differences between the groups was not statistically significant (P> 0.05). Compared with SAP group, Hcy in UAP group, QMI and NQMI group was significantly higher than that in SAP group (P <0.01). Compared with NQMI group, there was significant difference in Hcy between UA group and UAP group in QMI group (P <0.05). Hcy in SAP group had significant difference (P <0.01). ② The diagnostic sensitivity of each index of TBIL, UA, Hcy in coronary heart disease group was low and the specificity was relatively high. The diagnostic sensitivity of TBIL to coronary heart disease was 31.2%, specificity was 80%, and the positive and negative likelihood ratios were 1.56 and 0.86, respectively. The diagnostic sensitivity of Hcy to SAP was 50%, specificity was 82%, positive likelihood ratio was 2.78, and negative likelihood ratio was 0.61. UA diagnostic evaluation of CHD are low. ③ The TBIL area of different types of CHD and CHD groups were all greater than 0.5; except for the SAP group, the Hcy area was less than 0.5 in other groups; the area of UA was less than 0.5. Conclusion TBIL, UA and Hcy are closely related to the occurrence and development of CHD, and their diagnostic value for CHD is low, which may be a screening index for laboratory diagnosis of CHD.