缺血修饰白蛋白在慢性肾脏病合并心肌缺血中的诊断价值

Diagnosis valuation of ischemia-modified albumin in myocardial ischemia associzted to chronic kidney disease

目的评价血清缺血修饰白蛋白（IMA）水平在慢性肾脏病（CKD）患者并发心肌缺血中的诊断价值。方法选择非透析CKD患者100例，根据心肌缺血诊断标准分为。6肌缺血组、非心肌缺血组各50例，设健康对照组100例。检测血浆IMA水平及血清白蛋白、血红蛋白、心肌缺血面积等指标，并收集患者临床资料。分析各组患者IMA水平差异及其与各临床指标的的相关性。结果IMA水平在心肌缺血组及非心肌缺血组均升高，与健康对照组相比具有统计学差异（P〈0．01），心肌缺血组IMA较非心肌缺血组明显升高，具有统计学差异（P〈0．05）。Spearman相关分析显示，心肌缺血组IMA值与心肌缺血面积呈负相关，与白蛋白水平呈负相关，与血红蛋白水平呈正相关。IMA取截值91U／ml时，评价心肌缺血的灵敏度为96％，特异度为95％，ROC曲线下面积为98％。结论IMA是评价心肌缺血的灵敏指标，有望用于CKD患者心肌缺血的早期诊断、危险分层及预后判断。

Objective To discuss the value of ischmia-modified albumin in diagnosis of myocardial ischemia associated to chronic kidney disease. Methods Serum isehmia-modified albumin concentrations and albumin, hemoglobin, the area of myocardial ischemia were measured in the normal control group（n = 100） and 100 patients with CKD including myocardial ischemia group（n = 50） ,non myocardial isehemia group（n = 50）, and clinical data were collected. The differences of plasma IMA concentration and its relation with the clinical indexes were analyzed. Results IMA were elvated in both myocardial ischemia group and non myocardial ischemia group compared with the control group（P〈 0. 01） , IMA was higher in myocardial ischemia group than non myocardial ischemia （P〈0. 05）. Spearmam correalation analysis indicated IMA was negatively related with the area of myocardial ischemia and albumin, positively related with hemoglobin, sensitivity and speefieity at a cutoff valve of 91U/ ml were 96% and 95%, the area under ROC curve is 98 %. Conclusions IMA is a sensative biomarker for the evaluation of myocardial ischemia, may be applicated in the early diagnosis, risk stratification and judegement prognoses about myocardial ischemia asscociated to CKD.