血清缺血修饰蛋白对冠心病诊断价值的研究

Diagnostic value of serum ischemia modified albumin in coronary artery disease

目的探讨缺血修饰蛋白（IMA）在冠心病心肌缺血诊断中的价值。方法2009年11月至2010年5月，随机入选72例因临床疑诊冠心病心肌缺血而在我科住院治疗、且准备接受冠状动脉造影检查的患者。根据造影结果将患者分为冠心病组与非冠心病组，造影术前利用白蛋白结合钴试验（ACB试验）检测IMA水平。将冠状动脉造影结果作为诊断标准，采用受试者工作特性曲线（ROC曲线）下面积以及logistic回归分析IMA对冠心病心肌缺血诊断的价值。结果冠心病绀患者（51例）的缺血修饰蛋白水平为（97±24）U／ml，非冠心病组（21例）患者的IMA水平为（81±15）U／ml。当IMA的截断值为83．69U／ml时，其诊断冠心病心肌缺血的敏感性为80％，特异性为57％，阳性预测值为82％，阴性预测值为55％。logistic回归分析显示，高血压（P=0．022，b=1．421，OR=4．141）、IMA水平（P=0．003，b=1．780，OR=5．928）是冠心病心肌缺血发生的独立预测凶于。结论IMA水平在诊断冠心病心肌缺血方面具有较高的敏感性及阳性预测值，是冠心病心肌缺血发生的独立预测因子。

Objective To assess value of serum level of ischemia modified albumin （IMA） in diagnosis for myocardial ischemia of coronary artery disease （CAD）. Methods Seventy-two patients with clinically suspected myocardial isehemia of CAD admitted to The First People＇s Hospital of Hangzhou during November 2009 to May 2010 ready for undergoing coronary angiography, the gold standard for diagnosis of CAD, were randomly selected for the study. The patients were divided into CAD and non-CAD groups based on their coronary angiography. Serum level of IMA was determined with cobalt-albumin binding （ ACB ） assay before coronary angiography, which served as diagnostic standard for CAD. Logistic regression analysis method was used to evaluate varied levels of IMA with area under the receiver operating characteristic curve （AUCROC） in diagnosis for myocardial ischemia of CAD. Results Mean level of IMA was （97±24） U/ml and （81±15） U/ml for CAD group （n = 51 ） and non-CAD group （n = 21 ）, respectively. Sensitivity and specificity of a cut-off value of IMA 83.69 U/ml in diagnosis for myocardial ischemia of CAD was 80 percent and 57 percent, respectively, with a predictive value of a positive test 82 percent and that of a negative test 55 percent, respectively, from AUCROC. Logistic regression analysis demonstrated that both hypertension （P = 0. 022, b =1.421, OR=4. 141 ） and level of IMA （P =0. 003, b = 1. 780, OR =5. 928） were independeut predictors for CAD. Conclusions Sensitivity, specificity and predictive value of a positive test of the level of IMA are relatively high in diagnosis for myocardial ischemia of CAD, which is an independent predictor of it.