缺血修饰白蛋白在老年急性心肌缺血诊断中的应用价值

Clinical significance of ischemia modified albumin in early diagnosis of cardiac ischemia of elderly patients

目的探讨血清缺血修饰白蛋白(I MA)水平检测在老年心肌缺血诊断及鉴别诊断中的应用价值。方法采用白蛋白钴结合试验(ACB试验)间接测定50例急性冠状动脉综合征(ACS)、100例非缺血性心脏病(对照组)患者的血清I MA水平,比较ACS患者胸痛发作后3小时内血清ACB值与对照组患者血清ACB值的差异;比较ACS患者中不稳定型心绞痛(UA)患者与急性心肌梗死(AMI)患者ACB值差异;获得识别急性心肌缺血的最佳ACB值截断值。结果 ACS患者胸痛发作后3小时内血清ACB值为(79.62±9.20)kU/L,明显低于对照组(93.77±8.53)kU/L(P<0.01);UA患者胸痛发作后3小时内ACB值为(80.96±8.63)kU/L,与AMI患者的(79.48±11.06)kU/L比较差异无统计学意义(P>0.05)。应用受试者工作特征(ROC)曲线分析得出早期识别急性心肌缺血的ACB值截断值为85kU/L,以此值诊断急性心肌缺血的敏感度为88%,特异度为82%。结论 I MA是老年急性心肌缺血早期诊断的敏感生物标记物,但不是鉴别急性心肌缺血与AMI的生物学指标。应用ACB值最佳截断值诊断急性心肌缺血,有较高的敏感度和特异度。

Objective To investigate the early diagnostic value of ischemia modified albumin（IMA） for acute myocardial ischemia of elderly patients.Methods Serum IMA levels were measured by albumin-cobalt binding test（ACB test） in 50 patients with acute coronary syndrome（ACS） who suffered from chest pain within three hours and 100 patients with non-ischemia heart diseases.The ACB value was compared between two groups,and the value was also compared between patients with unstable angina（UA） and patients with acute myocardial infraction（AMI）.Receiver operating characteristic（ROC） curve analysis was used to determine the optimal cutoff value of this assay for early identifying cardiac ischemia.Results ACB value in ACS patients suffering from chest pain within 3 h was（79.62±9.20） kU/L,which was lower than that in control group（93.77±8.53） kU/L（P〈0.01）.There was no significant difference in ACB value between UA patients and AMI patients,（80.96±8.63） kU/L vs（79.48±11.06） kU/L（P〈0.05）.A cutoff value of 85 kU/L was obtained for early identifying acute myocardial ischemia by ROC curve analysis.The sensitivity and specificity of this cutoff value for acute myocardial ischemia were 88% and 82%,respectively.Conclusion IMA is a sensitive biomarker for early diagnosis of acute myocardial ischemia in elderly patients,but not a biomarker for identifying acute myocardial ischemia from AMI use of ACB best cutoff value has higher sensitivity and specificity for acute myocardial ischemia.