缺血修饰白蛋白在急性冠脉综合征早期诊断中的价值

Significance of Ischemia Modified Albumin for Early Diagnosis of Acute Coronary Syndrome

目的探讨缺血修饰白蛋白(IMA)对急性冠脉综合征(ACS)的早期诊断价值以及ACS患者血清IMA水平与冠状动脉病变程度的关系。方法在HITACHI公司7170全自动生化分析仪上,用间接白蛋白钴结合试验(ACB法)测定40例急性冠脉综合症患者(包括23例不稳定心绞痛患者和17例急性心肌梗死患者)、18例因胸痛入院的非ACS患者和102例健康门诊体检人员血清IMA含量。将IMA测定结果绘制ROC曲线并通过分析制定区分ACS与对照(非ACS胸痛患者和健康体检者)的最适cutoff值。将冠状动脉病变程度用Gensini积分表示,分析IMA值与冠脉病变严重程度的相关性。结果不稳定心绞痛组和急性心肌梗死组间IMA无差异无统计学意义,ROC曲线下面积为0.789,在cutoff值ABUS/ml=85.34时敏感性和特异性分别为79.2%和70.9%。IMA水平与反应冠脉病变严重程度的Gensini积分的相关系数为0.15。结论 IMA是心肌缺血的敏感指标,区分可逆性缺血与梗死的能力较差,不能反映冠状动脉病变程度。

Objective To evaluate the value of early diagonosis of ischemia modified albumin（IMA） in acute coronary syndrome.And to investigate the correlation between IMA level and severity of coronary artery disease.Methods Serum IMA levels of 40 cases diagnosed with acute coronary syndrome（ACS）,18 cases diagnosed with non-ischemia chest pain（NICP）,and 102 healthy individuals were detected by albumin cobalt binding test（ACB test） using HITACHI-7170 automatic biochemical analyzer.The optimal cutoff value of IMA was ascertained by receiver operating characteristic curve（ROC）.The severity of coronary artery lesion was evaluated by Gensini score,and ascertain the correlation between the levels of IMA and the Gensini score of coronary artery lesion.Results There was not a obvious distinction of IMA levels between unstable angina（UA） and acute myocardial infarction（AMI）.According to the ROC curve,when the cutoff value of IMA was 85.34ABSU/ml,the sensitivity and specificity were 79.2 % and 70.9% respectively,and the area under the curve is 0.789.The correlation coefficient is 0.15 between the IMA level and the Gensini score of severity of coronary artery disease.Conclusion These preliminary results suggest that IMA is a early sensitive biomarker for the assessment of myocardial ischemia but a poor discriminator between reversible myocardial ischemia and acute myocardial infarction （AMI）.There is no correlation between the level of IMA and severity of coronary artery disease.