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目的 探讨测定颈动脉内膜中层厚度(IMT)与同型半胱氨酸(Hcy)和D-二聚体(D-D)水平早期诊断急性冠状动脉综合征(ACS)的临床意义.方法 采用彩色多普勒超声测定178例ACS患者(稳定斑块72例和不稳定斑块106例)和83例稳定性心绞痛(SAP)患者的IMT,同时测定血清Hcy和D-D水平,并进行对比性研究.受试者工作特征(ROC)曲线评估稳定斑块向不稳定斑块转化时血清Hcy和D-D的水平.结果 ACS患者与SAP患者的性别、年龄、体质量指数(BMI)和糖尿病情况差异无统计学意义(P均>0.05).ACS患者血清Hcy和D-D水平较之SAP患者显著增高(P均<0.01).不稳定斑块患者血清Hcy和D-D水平较之稳定斑块患者明显增高(P<0.05,P0.05). The Hcy and D-D levels were significantly higher in ACS patients than those of SAP patients (P all<0.01). The Hcy and D-D levels were significantly higher in unstable plaque group than those of stable plaque group (P<0.05, P<0.01). The ROC curve showed: AUC of Hcy and D-D was 0.873 and 0.894, respectively; cut-off value was 7.88μmol/L and 0.56 μg/mL, respectively; sensitivity was 92.58% and 95.36%, respectively; specificity was 86.60%and 89.42%, respectively. Conclusion The severity of ACS can be identified by determining IMT level. The serum Hcy and D-D levels were valuable for predicting stable plaque translate to unstable plaque.