| Objective: Acute coronary syndrome(ACS) is often delayed diagnosis and therpiesbecause its clinical manifesations are diverse.The wo rld health organ ization estimatedthat to2020coronary heart disease will become the first killer of human health. Alongwith incr ease of its incidence, fast and accurate diagnosis and eff ective treatment ofACS has become a hot spot in the medical study.Cardiac markers are an important toolfor the diag nosis of A CS. At the moment “the golden standard” for the diagnosis ofACS is troponin, but it only raises in several hours of myocardial infarction occurs. Thisstudy is to evaluate CD148can efficiently help to diagnose patients with ACS andprovide valuable informations for risk stratification of ACS.Methods:150patients that arrived at hospital within12hr after the onset of chest painwere included,82male,and68female.All subjects were aged from38to80years old.According to the time inter val from onset of chest pain to arriving at the ho spital, wedivided the patients into≤3h,3-6h,and6-12h three groups. Besides,50healthy people inthe outpatient service were enrolled as control group. All suspected ACS patients withimmediate18line elec trocardiogram(ECG), and blood samples for the tro poninT(cTnT)、 CD148tests were taken at hos pital presentation. cTnT was de tected againwhen12hr after the onset of chest pain who cTnT was negtive for the first time.Coronary angiography was carried out for150patients. Two experienced doctors wereresponsible for assigning a final diagnosis on the basis of patients’ history, results ofECG, coronary angiography, and other examines as available. Of the enrolled patients,126were disch arged with a final diagnosis of A CS and24with the dia gnosis ofnonischemis chest pain(N ICP), cTnT＞0.05ng/ml,CD148＞14.385%were po sitive inthe study. The measure data was presented as mean±standard deviation, the couting datawas presented as number(percentage). Analysis were used to check differences betweengroups by SPSS16.0, p＜0.05was considered statistically significant.Results:1. Final diagnosis1.1126patients were dis charged with a final dia gnosis of A CS, of which50patients were AMI,15patients were UA of low risk,26patients were UA of middle risk and35patients were UA of high risk.1.224patients were discharged with a final diagnosis of NICP2.Analysis of receiver-operator characteristic curve(ROC curve)We took out patient service medical person as control group, patients of ACS asdisease group, and drawed the ROC curves by SPSS16.0.The op timum diagnosticcut-off point of CD148in the study population was found to be CD148＞14.385%thatdemonstrated a sensitivity of88.1%and a specificity of86%for the diagnosis of ACS.The area of ROC curve was0.919(95%CI0.882-0.970).3. Divided the patients according to risk stratification3.1At the basal levels of the six groups(normal control group,NICP, UA of lowrisk, UA of high risk and AMI)in terms of age, sex and serum creatinine, there was nostatistical differences(p＞0.05)3.2The relationship beween CD148and risk stratification3.2.1The CD148concentrations of normal control group, NICP, UA of low risk,U A of middle risk, U A of high risk,and AM I are12.48±2.48%、12.68±2.06%、20.84±5.99%、23.31±5.93%、22.79±6.92%、26.64±6.37%. There is no statisticaldifferdence between normal con trol group and N ICP group (p＞0.05)， but there isstatistical def ference between any other two groups(p＜0.05)。 Divided the patientsaccording to time interval4. Divided the patients according to time interval4.1At the basal levels of the three groups(≤3h,3-6h, and6-12h)in terms of age,sex,smoking,hypertension, hypercholesterolemia, family history of CAD, serum creatinine,body mass index, and diabetes mellitus, there is no statistical differences(p＞0.05)4.2Comparisions of sensitivity4.2.1In the group of≤3h, the sensitivities of cTnT, CK-MB, CD148fordiagnose ACS are33.33%,23.81%,64.29%respectively. The sensitivities of CD148issuperior to cTnT and CK-MB (p＜0.05) The sensitivity of cTnT is superior to CK-MB,there is statistical differences (p＜0.05).4.2.2In the group of3-6h, the sensitivities of cTnT, CK-MB, CD148fordiagnose ACS are38.78%,35.71%,83.33%, respectively. The sensitivities of CD148issuperior to cTnT and CK-MB (p＜0.05). The sensitivity of cTnT is superior toCK-MB,but there is no statistical differences (p＞0.05). 4.2.3In the group of6-12h, the sensitivities of cTnT, CK-MB, CD148fordiagnose ACS are57.14%,62.86%,88.57%, respectively. The sensitivities of CD148issuperior to cTnT and CK-MB (p＜0.05) The sensitivity of CK-MB is superior to cTnT,but there is no statistical differences (p＞0.05).4.3Comparisions of specificity4.31In the group of≤3h，the specificities of cTnT, CK-MB, CD148to diagnoseACS are100%,100%,90.47%, respectively. In three groups there is no statisticaldifferences(p＞0.05).4.3.2In the group of3-6h， the specificities of cTnT, CK-MB, CD148todiagnose ACS are100%,100%,100%, respectively. The specificities of cTnI andCK-MB,CD148are identical, there is no statistical differences(p＞0.05).4.3.3In the group of6-12h， the specificities of cTnT, CK-MB, CD148todiagnose ACS are100%,100%,91.43%, respectively. The specificities of cTnT andCK-MB are superior to CD148, there is no statistical differences(p＞0.05).Conclusions:1. The sensitivities of CD148to diagnose ACS superior to cT nT, especially in thefirst6hours after the onset of chest pain.2. The sensitivity of CD148is superior to cTnT and CK-MB, so when patients are justadmitted to hospital detecting CD148can more efficiently select the high riskpatients of ACS. |
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