黑龙江省哈尔滨市第四医院,黑龙江哈尔滨 150026
【摘要】目的:分析血清胱抑素C同型半胱氨酸和脂蛋白a联合诊断脑梗塞的临床效果。
方法:纳入脑梗塞病人共76为研究对象,病人就诊时间2019年1月到2020年1月。根据检测方法的不同分为参照组(38例)和联合诊断组(38例)。参照组(38例)接受血清胱抑素C同型半胱氨酸检查法进行检测。联合诊断组(38例)接受血清胱抑素C同型半胱氨酸和脂蛋白a联合检查技术进行检测。探讨两组检查诊断脑梗塞疾病诊断准确率。以临床综合诊断方法为金标准。探讨两组检查诊断脑梗塞疾病诊断的漏诊率、误诊率。结果:联合诊断组诊断脑梗塞疾病阳性36例,准确率94.74%,明显高于参照组的78.95%(P<0.05)。联合诊断组诊断脑梗塞疾病漏诊1例,漏诊概率2.63%,低于参照组的5.26%,但差异性没有统计学意义(P>0.05) ;联合诊断组诊断脑梗塞疾病误诊1例,误诊概率2.63%,明显低于参照组的15.79%(P<0.05)。结论:经血清胱抑素C同型半胱氨酸和脂蛋白a联合检查脑梗塞疾病诊断准确率明显高于单独采用血清胱抑素C同型半胱氨酸检查,误诊率明显低于单独采用血清胱抑素C同型半胱氨酸检查,诊断价值更高,可推广应用。
【关键词】脑梗塞;血清胱抑素C;半胱氨酸;脂蛋白a;联合诊断;临床效果;分析
Clinical effect of serum cystatin C, homocysteine and lipoprotein a in the diagnosis of cerebral infarction
Liu Hongyang, Xue Weishu, Li Chunheng, Wang Nan, Liu Lixin
(the fourth hospital of Harbin City, Heilongjiang Province, Harbin 150026, Heilongjiang Province)
[Abstract]Objective: to analyze the clinical effect of serum cystatin C, homocysteine and lipoprotein a in the diagnosis of cerebral infarction.Methods: a total of 76 patients with cerebral infarction were included in the study. The patients were treated from January 2019 to January 2020. According to different detection methods, they were pided into control group (38cases) and combined diagnosis group (38cases). The control group (38 cases) received serum cystatin C homocysteine test. The combined diagnosis group (38 cases) received the combined detection of serum cystatin C, homocysteine and lipoprotein a. Objective to investigate the diagnostic accuracy of cerebral infarction in two groups. The gold standard was clinical comprehensive diagnosis. Objective to investigate the missed diagnosis rate and misdiagnosis rate of cerebral infarction in the two groups. Results: 36 cases of cerebral infarction in the combined diagnosis group were positive, the accuracy rate was 94.74%, which was significantly higher than 78.95% of the reference group (P<0.05). In the combined diagnosis group, 1 case was missed diagnosis of cerebral infarction, the missed diagnosis probability was 2.63%, which was lower than 5.26% of the reference group, but the difference was not statistically significant (
P>0.05); 1 case of cerebral infarction disease was misdiagnosed in the joint diagnosis group, the misdiagnosis probability was 2.63%, which was significantly lower than 15.79% of the reference group (P<0.05). Conclusion: the diagnostic accuracy of combined detection of serum cystatin C homocysteine and lipoprotein a is significantly higher than that of serum cystatin C homocysteine alone, and the misdiagnosis rate is significantly lower than that of serum cystatin C homocysteine alone, and the diagnostic value is higher, which can be popularized and applied.
[Key words] cerebral infarction; serum cystatin C; cysteine; lipoprotein a; joint diagnosis; clinical effect; analysis
脑梗塞是局部脑组织缺血、缺氧性坏死的疾病类型,临床上较为常见[1]。血清胱抑素C同型半胱氨酸检查是脑梗塞疾病诊断的常用方法,但单独采用一种检查方法进行诊断,其误诊概率较高,易漏诊[2]。寻求选择诊断准确率高的方法,是本文研究的目的。近年来,血清胱抑素C同型半胱氨酸和脂蛋白a联合诊断在脑梗塞疾病诊断的临床诊断方面得到了一定的应用。因此,我院选择76脑梗塞病人为研究对象,以单独采用血清胱抑素C同型半胱氨酸检查为对照,探讨脑梗塞病人应用清胱抑素C同型半胱氨酸和脂蛋白a联合检查诊断的临床检验效果及准确度。
1.资料和方法
1.1资料
纳入脑梗塞病人共76为研究对象,病人就诊时间2019年1月到2020年1月。根据检测方法的不同分为参照组(38例)和联合诊断组(38例)。参照组中,病人共38例,男病人15例,女病人23例,最大75岁,最小58岁,平均(63.15±8.04)岁。联合诊断组中,病人共38例,男病人18例,女病人20例,最大77岁,最小57岁,平均(63.07±8.23)岁。
1.2方法。
参照组(38例)接受血清胱抑素C同型半胱氨酸检查法进行检测。清晨空腹条件下每位受检者抽取5mL静脉血,然后常规分离血清,清晨空腹条件下每位受检者抽取5mL静脉血,然后常规分离血清,用免疫比浊法检测血清胱抑素C水平值,使用酶法对血清Hcy进行检测。
联合诊断组(38例)接受血清胱抑素C同型半胱氨酸和脂蛋白a联合检查技术进行检测。采用血清胱抑素C同型半胱氨酸检查方法同参照组,在此基础上采用脂蛋白a检查。清晨空腹条件下每位受检者抽取5mL静脉血,然后常规分离血清,采用免疫比浊法检测脂蛋白a水平值,以上相关试剂盒均由上海纪宁实业有限公司提供。
1.3 评价指标
(1)探讨两组检查诊断脑梗塞疾病诊断准确率。以临床综合诊断方法为金标准。
(2)探讨两组检查诊断脑梗塞疾病诊断的漏诊率、误诊率。
1.4数据探讨与处理
采用生物统计学SPSS22.0软件处理,计量资料以( ±s)表示,采用t检验;脑梗塞疾病诊断准确率、脑梗塞疾病诊断的漏诊率、误诊率计数资料以相对数(%)表示,采用卡方检验。以P<0.05为差异有统计学意义。
结果
2.1探讨两组检查诊断脑梗塞疾病诊断准确率
联合诊断组诊断脑梗塞疾病阳性36例,准确率94.74%,明显高于参照组的78.95%(P<0.05)。见表1。
表1 探讨两组检查诊断脑梗塞疾病诊断准确率
组别 | 受检者 (例) | 脑梗塞疾病诊断阳性 (例) | 脑梗塞疾病诊断准确率 (%) |
参照组 | 38 | 30 | 78.95 |
联合诊断组 | 38 | 36 | 94.74 |
X2值 | | 4.1455 | |
P值 | | 0.0417 |
2.2探讨两组检查诊断脑梗塞疾病诊断的漏诊率、误诊率
联合诊断组诊断脑梗塞疾病漏诊1例,漏诊概率2.63%,低于参照组的5.26%,但差异性没有统计学意义(P>0.05) ;联合诊断组诊断脑梗塞疾病误诊1例,误诊概率2.63%,明显低于参照组的15.79%(P<0.05)。见表2。
表2 探讨两组检查诊断脑梗塞疾病诊断的漏诊率、误诊率
组别 | 受检者 (例) | 漏诊率 (例/%) | 误诊率 (例/%) |
参照组 | 38 | 2/5.26 | 6/15.79 |
联合诊断组 | 38 | 1/2.63 | 1/2.63 |
X2值 | | 0.3470 | 3.9337 |
P值 | | 0.2227 | 0.0473 |
3.讨论
普通情况下,临床针对疑似脑梗塞疾病诊断的临床检查方法主要通过血清胱抑素C同型半胱氨酸检查进行诊断[3],同型半胱氨酸是一种硫基氨基酸,光抑素C可抑制内源性半胱氨酸蛋白酶活性,对于脑梗塞形成有着重要的生理学影响[4]。但单独采用血清胱抑素C同型半胱氨酸检查,易发生误诊,影响病情确诊[5]。
近年来,血清胱抑素C同型半胱氨酸和脂蛋白a联合检查方法在脑梗塞疾病诊断的检查方面具有一定的应用,正常人体内脂蛋白a处于正常水平,当代谢发生异常时,脂蛋白a水平升高,导致脑梗塞等心脑血管疾病的发生[6]。本研究显示,经血清胱抑素C同型半胱氨酸和脂蛋白a联合检查脑梗塞疾病诊断准确率明显高于单独采用血清胱抑素C同型半胱氨酸检查(P<0.05),误诊率明显低于单独采用血清胱抑素C同型半胱氨酸检查(P<0.05),诊断价值更高,可推广应用。
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