心脏超声造影联合D-二聚体、高敏肌钙蛋白T诊断冠心病的效果及与冠状动脉病变程度的关系研究

The diagnostic efficacy of cardiac contrast-enhanced ultrasound combined with D-dimer and high-sensitivity troponin T for coronary heart disease and its correlation with coronary artery disease severity

摘要:

目的 分析心脏超声造影联合D-二聚体（D-D）、高敏肌钙蛋白T（hs-cTnT）水平诊断冠心病的效果及与冠状动脉病变程度的关系。方法 选取青岛市市立医院2022年1月—2023年12月收治的98例冠心病患者为观察组，另选取同期72例疑似但行冠状动脉造影排除冠心病的患者为对照组。患者入院首日行心脏超声造影检查，采用磁微粒化学发光免疫分析法检测hs-cTnT水平，双抗体夹心法检测D-D水平，比较观察组和对照组基础资料，分析冠心病患者发病的影响因素，受试者工作特征（ROC）曲线评估各指标对冠心病发病的诊断价值。根据Censini评分评估冠状动脉病变程度，并分为轻度组（< 25分，n = 26）、中度组（25～49分，n = 53）、重度组（≥ 50分，n = 19），比较不同冠状动脉狭窄程度患者D-D、hs-cTnT水平、心脏超声造影定量参数及相关性。结果 观察组BNP水平高于对照组（P <0.05）。观察组A值和β值均低于对照组，D-D和hs-cTnT水平均高于对照组（P <0.05）。多因素逐步Logistic回归分析结果显示：A值高（［O^R = 0.406（95% CI：0.287，0.573）］和β值高［O^R = 0.006（95% CI：0.001，0.050）］均为为冠心病发病的保护因素（P <0.05）；D-D水平高［O^R = 7.305（95% CI：2.758，19.352）］、hs-cTnT水平高［O^R = 8.118（95% CI：3.502，18.817）］和BNP水平高［O^R = 1.016（95% CI：1.009，1.024）］均是冠心病发病的危险因素（P <0.05）。ROC曲线分析结果显示，A值、β值、D-D、hs-cTnT水平及各项联合诊断冠心病患者发病的敏感性分别为61.2%（95% CI：0.538，0.694）、74.5%（95% CI：0.663，0.851）、63.3%（95% CI：0.539，0.718）、71.4%（95% CI：0.634，0.825）、89.8%（95% CI：0.803，0.980）；特异性分别为61.1%（95% CI：0.524，0.709）、58.3%（95% CI：0.509，0.694）、62.5%（95% CI：0.537，0.739）、61.1%（95% CI：0.525，0.734）、87.5%（95% CI：0.791，0.965）。A值、β值、D-D、hs-cTnT联合诊断冠心病患者发病的曲线下面积为0.878（95% CI：0.826，0.930），诊断价值较高。重度狭窄组、中度狭窄组和轻度狭窄组A值、β值、D-D、hs-cTnT水平比较，差异均有统计学意义（P <0.05）。结论 心脏超声造影定量参数（A值、β值）、D-D、hs-cTnT联合对冠心病患者发病的诊断价值较高。冠心病患者冠状动脉病变狭窄程度与D-D、hs-cTnT水平呈正相关，与心脏超声造影定量参数（A值、β值）呈负相关。

Abstract:

Objective To analyze the diagnostic efficacy of cardiac contrast-enhanced ultrasound (CEUS) combined with D-dimer (D-D) and high-sensitivity troponin T (hs-cTnT) for coronary heart disease (CHD) and their correlation with coronary artery disease severity.Methods Ninety-eight CHD patients admitted between January 2022 and December 2023 comprised the observation group; seventy-two patients with suspected CHD but excluded by coronary angiography during the same period served as controls. All underwent cardiac CEUS on admission day. Serum hs-cTnT was measured by magnetic particle chemiluminescence immunoassay; D-D was detected via double-antibody sandwich immunoassay. Baseline characteristics were compared. Multivariable analysis identified CHD risk factors. The diagnostic value of biomarkers was evaluated using ROC curves. Coronary disease severity was assessed by Censini score and stratified: mild group (< 25 points, n = 26), moderate group (25-49 points, n = 53), severe group (≥ 50 points, n = 19). D-D, hs-cTnT levels, CEUS quantitative parameters, and their correlations were compared across stenosis severity groups.Results Observation group exhibited higher BNP levels than controls (P < 0.05). Lower CEUS quantitative parameters [peak microbubble intensity (A value) and wash-in rate (β value) ] but elevated D-D and hs-cTnT levels were observed versus controls (P < 0.05). Multivariable logistic regression showed high A value [O^R = 0.406 (95% CI: 0.287, 0.573) ] and β value [O^R = 0.006 (95% CI:0.001, 0.050) ] were protective factors, while elevated D-D [O^R = 7.305 (95% CI:2.758, 19.352) ], hs-cTnT [O^R = 8.118 (95% CI: 3.502, 18.817) ], and BNP [O^R = 1.016 (95% CI: 1.009, 1.024) ] were risk factors (all P < 0.05). ROC analysis demonstrated diagnostic sensitivities: A value = 61.2% (95% CI:0.538, 0.694), β value = 74.5% (95% CI: 0.663, 0.851), D-D = 63.3% (95% CI: 0.539, 0.718), hs-cTnT = 71.4% (95% CI: 0.634, 0.825), combined = 89.8% (95% CI: 0.803, 0.980); specificities: A value = 61.1% (95% CI: 0.524, 0.709), β value = 58.3% (95% CI: 0.509, 0.694), D-D = 62.5% (95% CI: 0.537, 0.739), hs-cTnT = 61.1% (95% CI: 0.525, 0.734), combined = 87.5% (95% CI: 0.791,0.965). Combined markers yielded AUC = 0.878 (95% CI: 0.826, 0.930). Significant differences existed in A value, β value, D-D, and hs-cTnT levels across stenosis severity groups (P < 0.05). Coronary stenosis severity positively correlated with D-D and hs-cTnT levels but negatively correlated with A and β values (P < 0.05).Conclusions Combined CEUS quantitative parameters (A value, β value), D-D, and hs-cTnT demonstrate high diagnostic value for CHD. Coronary stenosis severity correlates positively with D-D/hs-cTnT levels and negatively with CEUS parameters.