В мире научных открытий (Mar 2018)
SELECTION OF OPTIMAL RISK ASSESSMENT OF ISCHEMIC HEART DISEASE FOR GENERAL PRACTITIONER
Abstract
The purpose of the study: analysis and establishment of a simple and valid laboratory test for diagnosis of coronary heart disease for doctors in medical institutions with poor material and technical equipment. Materials and methods: we performed a retrospective analysis of 960 laboratory parameters of patients the clinical diagnostic laboratory of Rostov state medical university for the treatment period from 2015 to 2017 and aged 25 to 78 years. The analysis included indices of glucose, creatinine, urea, aspartate aminotransferase, alanine aminotransferase and dyslipidemia panel. Sampling was carried out on the basis of full compliance with the indicators in each patient in view of the fact that not all patients had full range of research. In the end, the sample correlation range: glucose and dyslipidemia panel was 450 indicators for glucose, aspartate aminotransferase, alanine aminotransferase, creatinine and lipid 309 indicators for glucose, aspartate aminotransferase, alanine aminotransferase, creatinine, urea, and dyslipidemia panel 186 indicators. The grouping of lipid indicators was carried out in the following directions: – on the basis of the associated increased rate of glucose (≥6,1) as a probable equivalent of the marker in coronary artery disease group and normal (<6,1) the group B of the range of glucose and lipid profile. – on the basis of the associated high absolute increased aspartate aminotransferase (≥37) as the likely marker of coronary artery disease, group 1 and normal (<37), the group 2 of the range glucose, aspartate aminotransferase, alanine aminotransferase, creatinine and lipid profile. – on the basis of the associated high rate atherogenic coefficient (≥3) iTyG the group 1а and lowest (<3), the group 2в of the data range of glucose, aspartate aminotransferase, alanine aminotransferase, creatinine and lipid profile. Results: when comparing the two groups of indicators of lipid profile on the basis of the associated high and normal rate of glucose was obtained for cholesterol, triglycerides, low density lipoproteins t=0.3 mm, v≈956, p=0,76; t=4,2 v≈355, p=0,00003; t=0,2, v≈8, p=0,84, respectively. This way it is possible to reject the null hypothesis (H0) - only indicators triglycerides. When comparing the two groups of indicators of lipid profile in a spectrum characteristic of high and normal aspartate aminotransferase failed to reject H0 for cholesterol, triglycerides and low density lipoproteins at t=0,73, v≈876, p=0,47; t=1.14 and v≈481, p=0.25; t=0,54, v≈9, p=0.6, respectively. It means that relatively to the basis of the increased rate of aspartate aminotransferase statistically significant difference between associated lipid profile and lipid profile of normal increased aspartate aminotransferase, when initially provided that the investigated parameters had no correlation between them. When comparing two groups of indicators index triacylglyceride/glucose in the spectrum of high and reduced atherogenic coefficient failed to reject H0 when t=3,8, v≈192, p=0.0001. Consequently, when the prescribed laboratory is a risk of presence of atherosclerosis in the study group with elevated atherogenic coefficient significantly increases the level of the index triacylglyceride/glucose. Conclusion: thus, the study gave the opportunity: 1) to establish the highest clinical significance of glucose, atherogenic index and triglycerides of all the laboratory markers included in the sample for the diagnosis of coronary artery disease; 2) to choose the best laboratory test consisting of two test indicators: glucose and triglycerides, which correspond to the main “accessibility”; 3) to indicate the recommendation of the electrocardiogram and laboratory test analysis of glucose, atherogenic index and triglycerides, as sufficient to verify a diagnosis of coronary heart disease for doctors in medical institutions with poor material and technical equipment.
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