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目的探讨血清中超敏C反应蛋白(hs-CRP)、糖化血红蛋白(Hb A1c)联合纤维蛋白原(FIB)检测在2型糖尿病合并冠心病患者病情评估及预后判断中的应用。方法选取本院2013年11月-2015年12月收治的124例2型糖尿病患者,按照其是否合并冠心病分为合并冠心病组(A组)58例和无冠心病组(B组)66例,另选取同期健康体检者55例作为对照组。抽取所有受检者治疗前的空腹静脉血用于检测超敏C反应蛋白(hs-CRP)、糖化血红蛋白(Hb A1c)、纤维蛋白原(FIB)水平。A组患者采取介入治疗,治疗后随访12个月。统计对比3组hsCRP、Hb A1c、FIB的水平;比较A组患者中不同冠心病类型[稳定型心绞痛组(n=23)、不稳定型心绞痛组(n=19)和急性心肌梗死组(n=16)]hs-CRP、Hb A1c、FIB的表达水平;A组不同预后[预后良好组(n=23)、预后不良组(n=20)和预后严重不良组(n=15)]hs-CRP、Hb A1c、FIB的表达水平;分析hs-CRP、Hb A1c、FIB单独诊断与联合诊断对2型糖尿病合并冠心病的灵敏度、特异度、准确度。结果 A组hs-CRP、Hb A1c、FIB表达水平高于B组与对照组,B组hs-CRP、Hb A1c、FIB表达水平高于对照组,差异均有统计学意义(均P<0.05);急性心肌梗死组血清hs-CRP、Hb A1c、FIB水平均高于不稳定型心绞痛组与稳定型心绞痛组,不稳定型心绞痛组hs-CRP、Hb A1c、FIB水平均高于稳定型心绞痛组,差异有统计学意义(均P<0.05);预后严重不良组血清hs-CRP、Hb A1c、FIB水平均高于预后不良组与预后良好组,预后不良组hs-CRP、Hb A1c、FIB水平均高于预后良好组,差异有统计学意义(均P<0.05);hs-CRP、Hb A1c、FIB联合诊断的敏感度、特异度、准确度高于hs-CRP、Hb A1c、FIB单独诊断,差异有统计学意义(均P<0.05)。结论联合检测hs-CRP、Hb A1c、FIB可对2型糖尿病合并冠心病进行鉴别诊断,且能用于病情判断和预后评估,hs-CRP、Hb A1c、FIB联合检测对2型糖尿病合并冠心病诊断的敏感度、特异度及准确度较高,联合检测具有更高诊断价值。
Objective To investigate the application of serum hs-CRP, Hb A1c and fibrinogen (FIB) in the assessment of disease and prognosis in type 2 diabetic patients with coronary heart disease. Methods A total of 124 patients with type 2 diabetes admitted to our hospital from November 2013 to December 2015 were enrolled in this study. They were divided into two groups according to whether they had coronary heart disease or not: 58 patients with coronary heart disease (group A) and 66 patients without coronary heart disease (group B) Cases, another selection of 55 healthy subjects during the same period as a control group. Fasting venous blood was collected from all subjects before treatment for the detection of hs-CRP, Hb A1c, fibrinogen (FIB) levels. A group of patients take interventional therapy, followed up for 12 months after treatment. The levels of hsCRP, Hb A1c and FIB in the three groups were compared statistically. The levels of hsCRP, Hb A1c and FIB in the three groups were compared among different types of coronary heart disease (n = 23), unstable angina (n = 19) and acute myocardial infarction (N = 23), poor prognosis group (n = 20) and severe prognosis group (n = 15)], hs-CRP, Hb A1c and FIB; -CRP, Hb A1c and FIB in patients with type 2 diabetes mellitus were analyzed. The sensitivity, specificity and accuracy of hs-CRP, Hb A1c, FIB alone and combined diagnosis of type 2 diabetes mellitus with coronary heart disease were analyzed. Results The expression levels of hs-CRP, Hb A1c and FIB in group A were higher than those in group B and control group. The expression levels of hs-CRP, Hb A1c and FIB in group B were higher than those in control group (all P <0.05) . The levels of hs-CRP, Hb A1c and FIB in acute myocardial infarction group were higher than those in unstable angina group and stable angina group. The levels of hs-CRP, Hb A1c and FIB in unstable angina group were higher than those in stable angina group (All P <0.05). The levels of hs-CRP, Hb A1c and FIB in patients with severe prognosis were significantly higher than those with poor prognosis and good prognosis The sensitivity, specificity and accuracy of combined diagnosis of hs-CRP, Hb A1c and FIB were higher than those of hs-CRP, Hb A1c and FIB alone, respectively (all P <0.05) , The difference was statistically significant (both P <0.05). Conclusions Combined detection of hs-CRP, Hb A1c and FIB can differentiate type 2 diabetes mellitus patients with coronary heart disease, and can be used for judgment of disease and prognosis. Combined detection of hs-CRP, Hb A1c and FIB in patients with type 2 diabetes mellitus complicated with coronary heart disease The sensitivity, specificity and accuracy of diagnosis are higher, and joint detection has higher diagnostic value.