缺血修饰白蛋白及肌红蛋白在急性冠脉综合征早期的诊断意义

Evaluation of Ischemia Modified Albumin and Myohemoglobin in the Early Diagnosis of Acute Coronary Syndromes

目的:评价缺血修饰白蛋白(IMA)、肌红蛋白(Mb)及心电图(ECG)对急性冠脉综合征(ACS)的早期诊断价值。方法:115例在发病6h内就诊的ACS患者,包括不稳定性心绞痛(UA组)67例和心肌梗死(MI组)48例,均行心电图检查和血清IMA、Mb水平测定,并与对照组比较各组IMA及Mb水平差异,分析IMA、Mb和ECG单项或联合诊断ACS的敏感性。结果:UA和MI两组IMA水平均明显升高,而Mb仅在MI组升高,IMA单项诊断ACS的敏感度为88.70%,明显高于Mb(51.30%)和ECG(47.83%);IMA联合ECG或Mb以及三者联合诊断ACS的敏感度高达93.04%、94.78%及97.39%,均高于单项诊断的敏感性。结论:IMA是早期诊断ACS的敏感生化指标,尤其对UA的诊断有着较高的敏感性,IMA、Mb及ECG联合检测,可进一步提高对ACS的早期诊断价值。

Objective:To evaluate the early diagnosis value of ischemia modified albumin(IMA),myohemoglobin(Mb)and ECG for acute coronary syndrome(ACS).Method:The clinical data of 115 patients and 72 healthy volunteers were analyzed.All patients were finally diagnosed to be ACS in 6 hours between 2005 and 2007.Patients with ACS were divided into 67 cases of unstable angina(UA)group and 48 cases of myocardial infarction(MI)group.ECG of 187 people were recorded and blood samples of patients with UA and MI were collected to detect the level of IMA and Mb in blood to evaluate the difference of sensitivity between combination and solitary diagnosis by IMA,Mb and ECG.Results:The level of IMA in UA and MI group were both increased,however the level of Mb were elevated only in MI group.In UA group,IMA and Mb were significantly increased.The diagnosis sensitivity of IMA was 88.70%,which was significant higher than Mb(51.30%)and ECG(47.83%).Meanwhile,the diagnosis sensitivity of IMA combined with ECG or Mb were 93.04%,94.78% and 97.39% respectively,which was much higher than that of solitary diagnosis.Conclusion:IMA may make an early diagnosis of ACS and will improve the early diagnosis sensitivity especially for the patients of UA.Meanwhile,IMA combined with ECG and Mb can further increase the early diagnosis sensitivity of ACS.