目的:探讨心电图Tp-Te/QT值联合血清Ang Ⅱ水平对急性冠脉综合征(acute coronary syndrome,ACS)患者诊断及MACE事件评估价值。方法:选取因胸痛入院行冠脉造影患者243例,根据造影结果分为阴性对照组(CON组)、不稳定型心绞痛组(UAP组)和心肌梗死组(AMI组),获得患者临床资料和Tp-Te/QT值,通过酶联免疫吸附实验(enzyme linked immunosorbent assay, ELISA)检测血清Ang Ⅱ水平,分析Tp-Te/QT值和Ang Ⅱ水平在ACS诊断及预后评估中的意义。结果:相较于CON组,UAP组的年龄、TC水平及Tp-Te值较高(P＜0.05);与CON及UAP组相比,AMI组SCr、TC及D-dimer、Tp-Te、Tp-Te/QT值及Ang Ⅱ水平明显升高 (P＜0.05 );二元 Logistic回归分析结果显示Tp-Te/QT和Ang Ⅱ水平为AMI诊断的预测因素;在AMI诊断预测中受试者工作特征(receiver operating characteristic,ROC)曲线结果显示Tp-Te/QT值最佳截断值为0.29(敏感度55.6 %,特异度80.7 %),Ang Ⅱ最佳截断值为49.50 mg/L(敏感度83.3 %,特异度49.8 %),两指标联合预测能提升诊断特异度(敏感度63.9 %,特异度85.5 %);二元Logistic回归分析提示Tp-Te/QT值和血清AngⅡ水平是ACS患者MACE事件危险因素(P＜0.05),Tp-Te/QT评估MACE事件最佳截断值为0.30(敏感度66.70 %,特异度89.20 %),Ang Ⅱ最佳截断值为66.50 mg/L(敏感度75 %,特异度93.2 %),两指标联合预测能提升诊断敏感度(敏感度87.50 %,特异度89.80 %)。结论:Tp-Te/QT和血清Ang Ⅱ对AMI诊断及主要心血管不良事件(major adverse cardiovascular events,MACE)评估具有一定的预测价值,且两者联合预测时能提升AMI诊断的特异性及敏感性。
Objective: To explore the diagnostic and prognostic value of Tp-Te/QT ratio and serum Ang Ⅱ level in patients with acute coronary syndrome (ACS). Methods: A total of 243 patients who were admitted to the hospital for coronary angiography due to chest pain were selected and divided into the negative control group (CON group), unstable angina group (UAP group) and myocardial infarction group (AMI group) according to the results of the angiography. Tp-Te/QT ratio was tested and serum Ang Ⅱ levels were detected using enzyme-linked immunosorbent assay (ELISA) to evaluate the diagnostic and prognostic value of Tp-Te/QT ratio and Ang Ⅱ levels in patients with ACS. Results: Compared with the CON group, the UAP group had higher age, TC level and longer Tp-Te interval (P＜0.05). Compared with the CON and UAP group, the levels of SCr, TC, D-dimer and Ang Ⅱ, the Tp-Te interval and Tp-Te/QT ratio of the AMI group had were significantly increased (P＜0.05). The results of binary logistic regression analysis showed that Tp-Te/QT ratio and Ang Ⅱ levels were independent predictors in AMI diagnosis. The receiver operating characteristic curve(ROC curve) indicated that the best cut-off value of Tp-Te/QT is 0.29 (sensitivity 55.6 %, specificity 80.7 %), and the best cut-off value of Ang Ⅱ level is 49.50mg/L (sensitivity 83.3 %, specificity 49.8 %) ), the combined prediction of the two indicators can improve the diagnostic specificity (sensitivity 63.9 %, specificity 85.5 %). Binary logistic regression analysis suggested that Tp-Te/QT ratio and serum Ang Ⅱ levels were independent risk factors for MACE events (P＜0.05 ), and ROC results showed that the best cut-off value of Tp-Te/QT to evaluate MACE events was 0.30 (sensitivity 66.70 %, specificity 89.20 %), and the best cut-off value of Ang Ⅱ level was 66.50 mg/L (sensitivity 75 %, specificity 93.2 %), the combined prediction of the two indicators can improve the diagnostic sensitivity (sensitivity 87.50 %, specificity 89.80 %). Conclusion: Tp-Te/QT ratio and Ang Ⅱ level have certain predictive value in acute myocardial infarction (AMI) diagnosis and MACE event evaluation, and the combination of the two indicators can improve the specificity of AMI diagnosis and the sensitivity of MACE event evaluation.
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