Logistic回归联合受试者工作特征曲线评价血小板参数对急性冠脉综合征的诊断价值

Diagnostic value of platelet parameters for acute coronary syndrome by receiver operating characteristic curve and logistic regression

摘要:

目的 探讨平均血小板体积（MPV）和大型血小板比例（P-LCR）在胸痛患者急性冠脉综合征（ACS）中的诊断价值。方法 测定83例2013年1月至6月因胸痛就诊于空军总医院的ACS患者和56例非心源性胸痛患者的血小板参数，通过组间均值比较和logistic回归分析筛选出有效指标，并利用受试者工作特征（ROC）曲线评价其在ACS判断中的诊断价值。结果 （1）与非心源性胸痛患者相比，ACS患者血小板数量减少[（191.28±67.07）×109/L vs（236.75±64.09）×109/L]，MPV[（11.88±1.24） vs （10.73±1.08）fL]、血小板分布宽度（PDW）[（15.54±1.87） vs（13.40±2.35）fL]和P-LCR[（47.49±9.55）% vs （35.11±10.00）%]等明显升高（P＜0.05)；（2）不同临床类型的ACS患者血小板参数无显著变化（P＞0.05）；（3）logistic分析表明P-LCR和MPV是ACS的辅助诊断指标；（4）ROC曲线显示肌钙蛋白Ⅰ、P-LCR、MPV、肌酸激酶同工酶对应的诊断界值分别是0.15μg/L、38.5%、11.05fL和19.0U/L，曲线下面积分别为0.987，0.817，0.754和0.598，灵敏度为97.3%，92.8%，71.1%和45.8%，特异度为90.3%，64.3%，62.5%和73.2%，诊断符合率100%，80%，72.6%和67.2%。结论 MPV和P-LCR分别有助于ACS的发现，可作为胸痛患者ACS的辅助诊断指标，由于MPV和P-LCR升高对ACS的判断准确性较高，因此可以为ACS的早期判断和鉴别诊断提供参考。

Abstract:

Objective To determine the value of mean platelet volume (MPV) and platelet large cell ratio (P-LCR) in the diagnosis of acute coronary syndrome (ACS) in patients with chest pain. Methods A total of 83 chest pain patients with identified ACS and 56 chest pain patients without cardiovascular disease in our hospital from January to June 2013 were subjected in this study. Their venous blood samples were collected within 6 h of onset for platelet parameters. Mean comparison between the 2 groups and logistic regression analysis were used to find the effective platelet parameters, and receiver operating characteristic (ROC) curve analysis was used to evaluate their diagnostic significances for ACS. Results ACS group had significantly lower platelet than the non-cardiac chest pain group [(191.28±67.07)×109 vs (236.75±64.09)×109/L)], and significantly higher MPV [(11.88±1.24) vs (10.73±1.08)fL], platelet distribution width (PDW) [(15.54±1.87) vs (13.40±2.35)fL] and P-LCR [(47.49±9.55)% vs (35.11±10.00)%] (all P＜0.05). There was no statistical difference in the platelet parameters among different types of ACS patients (P＞0.05). Logistic regression analysis showed that P-LCR and MPV were auxiliary diagnostic indicatos for ACS. ROC curve analysis showed that the cut-off was 0.15μg/L, 38.5%, 11.05fL, and 19.0U/L, respectively, for troponin I (TnI), P-LCR, MPV and creatine kinase-MB (CK-MB), and their areas under the curve were 0.987, 0.817, 0.754 and 0.598, respectively. Their sensitivity was 97.3%, 92.8%, 71.1% and 45.8% respectively, the specificity were 90.3%, 64.3% 62.5%, and 73.2% respectively, and the diagnostic accuracy were 100%, 80%, 72.6%, and 67.2%, respectively for TnI, P-LCR, MPV and CK-MB. Conclusion MPV and P-LCR are helpful in the early diagnosis of ACS, and can be seperately used as auxiliary diagnostic indicators of ACS in patients with chest pain. Because of their high diagnostic accuracy, the 2 parameters can be served as a reference for early prediction and differential diagnosis of ACS.