缺血修饰白蛋白早期诊断非ST抬高型急性冠脉综合征的价值探讨

Evaluation on Ischemia Modified Albumin in the Early Diagnosis of Non-St-Segment Elevation Acute Coronary Syndromes

目的探讨缺血修饰白蛋白(IMA)对非ST抬高型急性冠脉综合征(NSTEACS)的早期诊断价值。方法 177例疑似NSTACS患者于胸痛发作6 h内采血,测定心肌肌钙蛋白(IcTnI);用间接白蛋白钴结合试验(ACB法)测定血清IMA值。且均经标准诊疗以及GRACE评分,并根据最终诊断分为NSTEMI组(n=34)、不稳定型心绞痛(UA)组(n=56)和非缺血性胸痛(NICP)组(n=87)。另随机选取本院同期行健康体检者58例作为健康对照组。通过绘制IMA诊断NSTEACS的受试者工作特征(ROC)曲线,取得判定IMA的最佳临界值。将IMA、心电图和cTnI单独或联合诊断与最终诊断进行综合分析。结果 NSTEMI组与UA组IMA水平无显著性差异;NSTEMI组、UA组与NICP组比较,其IMA水平均有显著性差异。ROC曲线下面积0.950,Cut-o值取67.49 U/mL时,诊断NSTEACS的敏感性和特异度分别为91.1%和86.2%。IMA水平与GRACE评分呈显著负相关。结论 IMA是早期诊断NSTEACS的敏感指标,并有助于判断患者的预后。

Objective To evaluate the early diagnostic value of ischemia modified albumin（IMA） for non-ST-segment elevation acute coronary syndromes（NSTEACS）.Methods The study group consisted of 177 patients with suspected NSTEACS whose blood was collected within six hours after the onset of chest pain to determine cardiac troponin I（cTnI）,and IMA was determined through the albumin cobalt binding（ACB） test.After standardized diagnosis and treatment and GRACE risk score,the patients then were divided into three groups according to the final diagnosis： the NSTEMI（non-ST-segment elevation myocardial infarction） group（n=34）,the UA（unstable angina pectoris） group（n=56） and the NICP（non-ischemia chest pain） group（n=87）.Meanwhile,58 people taking the routine examination in the same hospital at that time were randomly selected as the control group.With the results of IMA,ROC curve analysis was used to determine the optimal cutoff of this assay for identifying patients with NSTEACS from those with NICP.Results of IMA,ECG and cTnI were correlated with final diagnosis,and their diagnostic sensitivity and specificity were evaluated for NSTEACS.Results The IMA concentration in the serum showed no significant difference between the NSTEMI group and the UA group,whereas there were significant differences between the former two groups and the NICP group.The sensitivity and specificity at a cutoff point 67.49 U/mL were 91.1% and 86.2%,respectively when the ROC curve area was 0.950.The correlation between the IMA concentration and GRACE risk score was negative.Conclusion IMA is an early sensitive indicator for NSTEACS and a useful predictor of prognosis.