Nghiên cứu vai trò chẩn đoán của IMA (Ischemia Modified Albumin) huyết thanh phối hợp với hs-Troponin T ở bệnh nhân hội chứng vành cấp

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Tác giả: Văn Minh Huỳnh, Tá Đông Nguyễn, Quang Tuấn Phạm, Thị Hạ Thi Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học lâm sàng Bệnh viện Trung ương Huế, 2023

Mô tả vật lý: tr.80-88

Bộ sưu tập: Báo, Tạp chí

ID: 343048

Thêm vào giỏ Liên kết toàn văn

Mục tiêu: Nghiên cứu này xác định nồng độ IMA và hs-TnT ở bệnh nhân HCVC. Xác định độ nhạy, độ đặc hiệu khi phối hợp IMA và hs-TnT trong chẩn đoán HCVC. Đối tượng, phương pháp: 253 bệnh nhân nhập viện tại Bệnh viện Trung ương Huế với các triệu chứng nghi ngờ HCVC trong đó 130 bệnh nhân được chẩn đoán HCVC theo đồng thuận NMCT toàn cầu lần IV năm 2018 và 123 bệnh nhân còn lại không bị HCVC làm nhóm đối chứng. Phương pháp nghiên cứu mô tả cắt ngang có so sánh. Kết quả: Nồng độ hs-TnT và IMA ở nhóm bệnh cao hơn nhóm chứng. Nồng độ hs-TnT ở nhóm bệnh nhân HCVC cao hơn nhóm đối chứng có ý nghĩa ở cả hai thời điểm (trung vị là 0,23ng/mL >
0,006ng/mL và 1,26ng/mL >
0,006ng/m (p <
0,001). Nồng độ IMA trung bình 79,26 ± 114,15 IU/mL (trung vị là 46,26 IU/mL) ở nhóm HCVC cao hơn nhóm đối chứng 24,23 ± 27,14 IU/mL (trung vị là 17,45 IU/mL)
(p <
0,001). Điểm cắt chẩn đoán HCVC của hs-TnT1 là 0,0165 ng/mL có độ nhạy 84,3%, độ đặc hiệu 87,8%, diện tích dưới đường cong ROC là 0,90 với p <
0,001, 95% KTC: 0,86 - 0,94. Điểm cắt chẩn đoán HCVC của hs-TnT2 là 0,0165 ng/mL có độ nhạy 89%, độ đặc hiệu 88,6%, diện tích dưới đường cong ROC là 0,93 với p <
0,001, 95% KTC: 0,89 - 0,97. Điểm cắt Delta hs-TnT >
0,008 ng/mL, độ nhạy 53,08%, độ đặc hiệu 98,37%, diện tích dưới đường cong ROC: 0,621 (95% KTC: 0,56 - 0,68), p <
0,05. Phối hợp IMA và hs-TnT1 trong chẩn đoán HCVC thì độ đặc hiệu tăng lên 98,37% và giá trị tiên đoán dương tăng 97,87%. Phối hợp IMA và hs-TnT2 trong chẩn đoán HCVC thì độ đặc hiệu và giá trị tiên đoán dương hầu như không thay đổi. Với điểm cắt hs-TnT là 0,014ng/mL thì độ nhạy và độ đặc hiệu của hs-TnT1 trong chẩn đoán HCVC tương ứng là 84,62% và 85,37% và hs-TnT2 tương ứng là 88,46% và 86,99%. Khi phối hợp IMA với hs-TnT tại điểm cắt 0,014 ng/mL thì độ nhạy và độ đặc hiệu của IMA và hs-TnT1 trong chẩn đoán HCVC tương ứng là 70,77% và 98,37% và hs-TnT2 tương ứng là 73,85% và 98,37%. Kết luận: Phối hợp IMA và hs-TroponinT có giá trị chẩn đoán HCVC cao hơn so với hs-Troponin T hoặc IMA đơn độc. Từ khóa: hs-Troponin T, IMA, Hội chứng vành cấp. ABSTRACT The diagnostic value of serum IMA (Ischemia - Modified Albumin) in combination with hs- Troponin T in patients with acute coronary syndrome Pham Quang Tuan1, Tran Thi Ha Thi2, Nguyen Ta Dong1, Huynh Van Minh3 Aim: To determine serum IMA and hs-TnT levels in the ACS patients. To determine / and the sensitivity and the specificity when combining serum of the combined use of IMA and hs-TnT in the diagnosis of ACS. Methods: 253 patients admitted to Hue Central Hospital were divided into 2 groups. The study group included 130 patients diagnosed with ACS according to the Fourth Universal Definition of Myocardial Infarction Consensus 2018. Meanwhile, 123 non - ACS patients belonged to the control group. A cross-sectional study was conducted. Results: The concentrations of hs-TnT and IMA in the study group were higher than those in the control group. The concentration of hs-TnT in the ACS group was significantly higher than those in the control group at both time points (median 0.23ng/mL >
0.006ng/mL and 1.26ng/mL >
0.006ng/mL) (p <
0.001). Mean serum IMA levels of patients in the ACS group was higher than, 79.26 ± 114.15 IU/mL (median 46.26 IU/mL) versus 24.23 ± 27.14 IU/mL (median 17. 45 IU/mL)
(p <
0.001). (Đã sửa theo ý kiến phản biện). The diagnostic cut-off point for ACS of hs-TnT1 was 0.0165 ng/ mL with sensitivity 84.3%, specificity 87.8%, area under the ROC curve 0.90 with p <
0.001, 95% CI : 0.86 - 0.94. The diagnostic cut - off point for ACS of hs-TnT2 was 0.0165 ng/mL with sensitivity 89%, specificity 88.6%, area under the ROC curve 0.93 with p <
0.001, 95% CI: 0 .89 - 0.97. (hs-TnT2 - hs-TnT1) cut - off >
0.008 ng/mL was significant in the diagnosis of ACS, sensitivity 53.08%, specificity 98.37%, area under the ROC curve: 0.621 (95% CI: 0.56 - 0.68), p <
0.05. The combined use of IMA and hs-TnT1 in the diagnosis of ACS, the specificity increased to 98.37% and the positive predictive value enhanced 97.87%. Meanwhile, the specificity and positive predictive value of IMA and hs-TnT2 in the diagnosis of ACS were almost unchanged. With an hs-TnT cut - off of 0.014ng/mL, the sensitivity and specificity of hs-TnT1 in the diagnosis of ACS were 84.62% and 85.37% and hs-TnT2 respectively 88.46% and 86.99%. When IMA was combined with hs-TnT at the cut - off point of 0.014 ng/ml, the sensitivity and specificity of IMA and hs-TnT1 in the diagnosis of ACS were 70.77% and 98.37% and hs-TnT2 are 73.85% and 98.37%, respectively. Conclusion: The combined use of IMA and hs-TroponinT has a higher diagnostic value of ACS than hs-Troponin T or IMA alone..

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