缺血修饰清蛋白的检测在亚急性心肌梗死延迟PCI治疗中的价值

Role of the Detection of Ischemia Modified Albumin for Percutaneous Coronary Intervention in Patients with Subacute Myocardial Infarction

目的观察亚急性心肌梗死发生后14 d进行经皮冠状动脉介入治疗(PCI)前后缺血修饰清蛋白(IMA)的水平变化。方法对80例发病后14 d的亚急性心肌梗死患者进行延迟PC I治疗。其中45例为梗死相关血管(IRA)持续完全闭塞的延迟PC I治疗患者(IRA未再通组),35例为梗死相关血管已获再通的患者(IRA再通组),术前、术后0.5、6、12 h检测两组患者的血浆IMA、心肌肌钙蛋白(cTn)、肌酸激酶同工酶(CK-MB)水平。结果 IRA再通组患者的IMA在术后0.5 h与术前比较明显升高,差异有统计学意义(P<0.05),并于术后6 h恢复至术前水平。IRA未通组患者PC I治疗后,IMA有轻微的改变。IRA再通组患者介入治疗后12 h,cTn有轻微的升高,其他时间点检测变化不明显。两组患者的CK-MB水平于术前以及介入后各个时间点的变化不明显,差异无统计学意义(P>0.05)。结论与cTn、CK-MB等心肌损伤标志物相比,IMA具有敏感性更高、出现时间更早等优势,在亚急性心肌梗死延迟PC I治疗后检测IMA有一定的参考价值。

Objective To investigate changes of plasma level of ischemia modified albumin（IMA）in patients with subacute myocardial infarction before and after successful coronary artery stent placement.Methods 80 patients with subacute myocardial infarction（10～14days after attack）who were divided into two groups： 45 patients with reflowed infarction relative artery（IRA）,and 35 patients with occluded IRA.All the patients received successful percutaneous coronary intervention（PCI）.The plasma levels of IMA,cTnT and CK-MB were measured before,0.5h,6 h,12h after PCI.Results IMA elevated half an hour after PCI significantly in those patients with unoccluded IRA,and the level of IMA restored to preoperative levels within 6 h after PCI.while no significant changes in those with occluded IRA.cTn increased slightly in the IRA reperfusion group with PCI after 12 h,and the level of cTn have no change at the other time points.The level of CK-MB in two groups have no obvious changes at all time points,the difference was not statistically significant（P0.05）.Conclusion Compared to the other markers of myocardial injury,IMA has the advantages of higher sensitivity and appear earlier,it has certain value for detecting IMA in subacute myocardial infarction with PCI.