高密度脂蛋白、视黄醇结合蛋白4联合24 h动态心电图诊断冠心病并发无症状心肌缺血的价值

胡皓; 李慧芳; 王铮亮

doi:10.14188/j.1671-8852.2024.0270

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高密度脂蛋白、视黄醇结合蛋白4联合24 h动态心电图诊断冠心病并发无症状心肌缺血的价值

临床医学研究 | 更新时间：2026-11-05

- 高密度脂蛋白、视黄醇结合蛋白4联合24 h动态心电图诊断冠心病并发无症状心肌缺血的价值
- Diagnosis value of high density lipoprotein, retinol binding protein 4 associated with 24 h DCG in coronary heart disease with asymptomatic myocardial ischemia
- 武汉大学学报（医学版） 2025年46卷第9期页码：1174-1178
- 作者机构：
  
  1.太和医院/湖北医药学院附属医院心内科湖北十堰 442099
  2.湖北省第三人民医院心内科湖北武汉 430022
- 作者简介：
  
  胡皓，男，1987—，主治医师，主要从事心内科基础及临床研究，E‑mail: huh121314@163.com
- 基金信息：
  
  湖北省科技计划项目(2021CFC843)
- DOI：10.14188/j.1671-8852.2024.0270
  中图分类号： R541
- 收稿：2024-04-15，
  
  纸质出版：2025-09-26
- 稿件说明：
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胡皓,李慧芳,王铮亮.高密度脂蛋白、视黄醇结合蛋白4联合24 h动态心电图诊断冠心病并发无症状心肌缺血的价值[J].武汉大学学报（医学版）,2025,46(09):1174-1178.

HU Hao,LI Huifang,WANG Zhengliang.Diagnosis value of high density lipoprotein, retinol binding protein 4 associated with 24 h DCG in coronary heart disease with asymptomatic myocardial ischemia[J].Medical Journal of Wuhan University,2025,46(09):1174-1178.
胡皓,李慧芳,王铮亮.高密度脂蛋白、视黄醇结合蛋白4联合24 h动态心电图诊断冠心病并发无症状心肌缺血的价值[J].武汉大学学报（医学版）,2025,46(09):1174-1178. DOI： 10.14188/j.1671-8852.2024.0270.

HU Hao,LI Huifang,WANG Zhengliang.Diagnosis value of high density lipoprotein, retinol binding protein 4 associated with 24 h DCG in coronary heart disease with asymptomatic myocardial ischemia[J].Medical Journal of Wuhan University,2025,46(09):1174-1178. DOI： 10.14188/j.1671-8852.2024.0270.

摘要

目的

观察冠心病无症状心肌缺血患者24 h动态心电图（DCG）与高密度脂蛋白颗粒大小、视黄醇结合蛋白4（RBP4）的变化情况，并分析其对患者发生无症状心肌缺血（SMI）的诊断价值。

方法

纳入2022年5月—2023年5月收治的冠心病患者108例，观察发生SMI的患者与非SMI患者24 h DCG和高密度脂蛋白颗粒大小相关量化指标[高密度脂蛋白胆固醇/载脂蛋白A1（HDL‑c/ApoA1）]、RBP4变化情况，并分析这些指标的变化对患者发生SMI的诊断价值。

结果

经24 h DCG评估发现SMI组中阳性患者共有57例，诊断准确率为82.61%（57/69），发作时间段主要集中在6:00—11:59时间段；SMI组患者RBP4水平明显高于非SMI患者，而HDL‑c/ApoA1则明显低于非SMI患者（均

0.05）；经Spearman法分析显示，冠心病患者发生SMI与RBP4水平呈正相关性（

=0.450，

0.05），与HDL‑c/ApoA1水平呈负相关性（

=-0.347，

0.05）；经ROC曲线分析显示：24 h DCG、HDL‑c/ApoA1、RBP4水平对冠心病发生SMI诊断的曲线下面积（

AUC

）分别为0.798、0.708、0.771，三项联合诊断的

AUC

为0.891，明显高于各单项指标（

0.05），此时诊断的敏感度和特异度分别为0.899、0.795。

结论

24 h DCG对冠心病患者发生SMI具有一定的诊断价值，联合HDL‑c/ApoA1、RBP4诊断则可进一步提高诊断的价值。

Abstract

Objective

To investigate the changes of 24 h dynamic electrocardiogram (DCG)

high density lipoprotein (HDL) particle size and retinol binding protein 4 (RBP4) in patients with silent myocardial ischemia (SMI) of coronary heart disease (CHD)

and to evaluate their diagnostic value in SMI.

Methods

A total of 108 patients with CHD were enrolled from May 2022 to May 2023. The changes of 24 h DCG

HDL particle size and RBP4 in SMI patients and non‑SMI patients were observed

and the diagnostic value of these changes in SMI patients was analyzed.

Results

Fifty⁃seven SMI positive patients were evaluated by 24 h DCG

the diagnostic accuracy was 82.61%(57/69)

the onset time was mainly concentrated in 6:00⁃11:59

RBP4 level was significantly higher and HDL‑c/ApoA1 was significantly lower in SMI group than in non‑SMI group. Spearman analysis showed that SMI was positively correlated with RBP4 level in patients with CHD (

=0.450

0.05)

and there was a negative correlation between HDL‑c/ApoA1 and HDL‑c/ApoA1(

=-0.347

0.05). ROC curve analysis showed that the

AUC

of 24 h DCG

HDL‑c/ApoA1 and RBP4 for SMI diagnosis was 0.798

0.708 and 0.771

respectively. The

AUC

of combined diagnosis was 0.891

which was significantly higher than that of individual indexes (

0.05). The sensitivity and specificity of diagnosis were 0.899 and 0.795 respectively.

Conclusion

24 h DCG has certain diagnostic value for SMI in patients with coronary heart disease

and the combination of HDL‑c/ApoA1 and RBP4 can further improve the diagnostic value.

关键词

Keywords

references

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