Calmarza Pilar, Lapresta Carlos, García-Castañón Sandra, López-Perales Carlos, Pérez-Guerrero Ainhoa, Portolés Ana
Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España.
Servicio de Medicina Preventiva, Hospital de Barbastro, Zaragoza, España.
Clin Investig Arterioscler. 2016 Sep-Oct;28(5):209-215. doi: 10.1016/j.arteri.2016.07.001. Epub 2016 Sep 17.
This study was conducted in order to evaluate the usefulness of copeptin (a stable fragment of the precursor of arginine vasopressin) in the differential diagnosis of acute chest pain of probable coronary origin.
The study includes 82 patients who were initially evaluated according to the protocol of a patient with suspected acute coronary syndrome (ACS) in our Emergency Department, including the determination of troponin and copeptin with specimens taken on admission (time 0) and at 6h.
Statistically significant differences were observed in copeptin concentrations at time 0 among patients diagnosed with non-ST-segment elevation (NTEACS): 42.1±38.7pmol/L and non-NSTEACS patients: 15.6±21.2pmol/L (P<. 01). However, the differences did not reach statistical significance at 6h (P=.093). The analysis of the area under the ROC curve for Copeptin in NSTEACS patients at time 0 was 0.713, with a confidence interval of 95% from 0.592 to 0.834 and a significance level of P=.001.
The concentration of copeptin represents an additional value in the differentiation between NSTEACS patients and non-NSTEACS patients, as well as between ACS patients and patients with stable angina. The cut-off point of 10pmol/L provides the best values for sensitivity, negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) in the diagnosis of NSTEACS patients.
本研究旨在评估 copeptin（精氨酸加压素前体的稳定片段）在可能由冠状动脉起源的急性胸痛鉴别诊断中的作用。
该研究纳入了 82 例患者，这些患者最初在我们急诊科按照疑似急性冠状动脉综合征（ACS）患者的方案进行评估，包括在入院时（时间 0）和 6 小时时采集标本测定肌钙蛋白和 copeptin。
在诊断为非 ST 段抬高（NTEACS）的患者中，时间 0 时 copeptin 浓度为 42.1±38.7pmol/L，非 NSTEACS 患者中为 15.6±21.2pmol/L，二者之间观察到有统计学显著差异（P<0.01）。然而，在 6 小时时差异未达到统计学显著水平（P = 0.093）。NSTEACS 患者在时间 0 时 Copeptin 的 ROC 曲线下面积分析为 0.713，95%置信区间为 0.592 至 0.834，显著性水平为 P = 0.001。
copeptin 浓度在 NSTEACS 患者与非 NSTEACS 患者之间以及 ACS 患者与稳定型心绞痛患者之间的鉴别中具有额外价值。10pmol/L 的截断点在 NSTEACS 患者诊断中提供了最佳的敏感性、阴性预测值（NPV）、阳性似然比（LR+）和阴性似然比（LR-）值。
