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目的探讨和肽素(Copeptin)在非ST段抬高急性冠脉综合征诊断中的应用研究。方法收集在上海市浦东医院心内科收治发病4 h内的非ST段抬高急性冠脉综合征患者120例(观察组),随机选取40例冠脉造影无异常患者为对照组。检测患者发病后4 h、12 h和24 h的血浆Copeptin及超敏肌钙蛋白I(cTnI),并与对照组比较。通过ROC曲线评估Copeptin的最佳诊断点,计算敏感性及特异性。结果在发病后4 h、12 h和24 h中,患者血浆Copeptin和cTnI水平明显高于对照组,差异有统计学意义(P<0.05)。对NSTE-ACS组不同时间段血浆Copeptin和cTnI水平进行组内比较,差异有统计学意义(F分别=5.87、12.36,P均<0.05)。通过ROC曲线,Copeptin的最大曲线下面积(AUC)为0.739,最佳诊断点为11.03 pmol/L,此时诊断NSTE-ACS的敏感性为90.0%,特异性为67.5%。而cTnI以0.05 ng/ml为诊断临界点,诊断NSTE-ACS的敏感性为51.9%,特异性为95.0%。结论和肽素对非ST段抬高急性冠脉综合征的诊断敏感性优于超敏肌钙蛋白I,具有较好的诊断价值,值得临床应用。
Objective To investigate the application of Copeptin in the diagnosis of non-ST segment elevation acute coronary syndrome. Methods Totally 120 patients with non-ST segment elevation acute coronary syndrome within 4 hours of onset were enrolled in Department of Cardiology, Pudong Hospital of Shanghai. 40 patients with coronary artery disease without coronary artery disease were randomly selected as the control group. Plasma Copeptin and cTnI were measured at 4 h, 12 h and 24 h after onset, and compared with the control group. The best diagnostic point for Copeptin was evaluated by ROC curve to calculate the sensitivity and specificity. Results The plasma levels of Copeptin and cTnI were significantly higher in the 4 h, 12 h and 24 h after onset than those in the control group (P <0.05). The levels of plasma Copeptin and cTnI in the NSTE-ACS group were significantly higher than those in the NSTE-ACS group (F = 5.87,12.36, P <0.05, respectively). According to the ROC curve, the maximum area under curve (AUC) of Copeptin was 0.739 and the best diagnostic point was 11.03 pmol / L. The sensitivity and specificity of NSTE-ACS were 90.0% and 67.5% respectively. The cTnI 0.05 ng / ml for the diagnosis of critical point, the diagnosis of NSTE-ACS was 51.9%, specificity was 95.0%. Conclusions Copeptin is superior to hypersensitive troponin I in the diagnosis of non-ST-segment elevation acute coronary syndromes, which has a good diagnostic value and is worthy of clinical application.