logistic回归联合roc曲线评价血小板参数对急性冠脉综合征的诊断价值.doc

·临床研究· Logistic回归联合ROC曲线评价血小板参数对急性冠脉综合征的诊断价值 苏 丹，魏 璇* （解放军空军总医院干部病房，北京 100142） 【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例因胸痛就诊的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PLT数量减少[（191.28±67.07）×109/L vs（236.75±64.09）×109/L]，MPV[（11.88±1.24）fL vs（10.73±1.08）fL]、PDW[（15.54±1.87）fL 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、MPV是ACS的辅助诊断指标；（4）ROC曲线显示TnI、P-LCR、MPV、CK-MB对应的诊断界值分别是0.15ng/mL、38.5%、11.05fL和19.0U/L，曲线下面积分别为0.987、0.817、0.754、0.598，灵敏度为97.3%、92.8%、71.1%、45.8%，特异度为90.3%、64.3%、62.5%、73.2%，诊断符合率100%、80%、72.6%、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。 【关键词】急性冠脉综合征；平均血小板体积；大血小板比率；Logistic回归；ROC曲线；胸痛 【中图分类号】 R? 【文献标识码】 A 【DOI】 ? Diagnostic value of platelet parameters for acute coronary syndrome by ROC curve and logistic regression SU Dan, WEI Xuan* (Department of Cadres Ward, Air Force General Hospital, Beijing 100142, China) 【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 PLT was in than in the non-cardiac chest pain group [(191.28?7.07)?09 vs (236.75?4.09)?09/L)], and significantly higher MPV (11.88?.24 vs 10.73?.08) fL), PDW (15