胸痛6h内缺血修饰白蛋白对急性心肌梗死预后的价值研究

The association between ischemia modified albumin and the cardiac outcome in patients with acute myocardial infarction

目的探讨胸痛6h内缺血修饰白蛋白（IMA）对急性心肌梗死（AMI）预后的预测价值。方法收集武汉大学人民医院心血管内科2009年10月至2010年4月确诊为AMI患者85例。所有患者于胸痛6h内测定IMA和心脏肌钙蛋I（cTnI），按照指南进行标准化治疗。随访6个月内心血管事件的发生情况。根据心血管事件的发生与否进行分组，分为心血管事件组和无心血管事件组。结果85例患者中，80例随访有效，其中心血管事件组19例（23．75％），无心血管事件组61例（76．25％），心血管事件组的血清IMA高于无心血管事件组[（107．34±14．04）U／mL对（86．9±12．27）U／mL，P〈0．01]。对其他心血管危险因素进行校正后，IMA仍然是心血管事件的独立危险因素（0R=1．64，95％CI：1．2—2．14，P=0．01）。结论胸痛6h内的IMA对急性心肌梗死患者6个月心血管事件有很好的预测作用。

Objective To investigate the possible association between ischemia modified albumin （IMA） on a sample taken within 6 h after episode of chest pain and the cardiac outcome in patients with established acute myocardial infarction （AMI）. Methods 85 patients were enrolled with established AMI within 6 h of the onset of chest pain. Plasma concentrations of IMA and cardiac troponin I （cTnI） were measured immediately. Patients＇ characteristics, cardiovascular risk factors and clinical outcomes of 6 months were recorded. Patients were divided into two groups according to the outcome：reach the end point or not reach the end point. Results 80 cases were followed-up within 6 months and efficient rate was 94. 1%. Of the 80 patients, 19 （23.75%） reached the end point and 61 （76.25%） did not reach the end point. Serum IMA concentration were significantly higher in patients that reached the end point （ 107.34 ± 14. 04 u/mL VS 86. 9 ± 12. 27 u/mL,P 〈0. 01 ）. Age,left ventricular ejection fraction,cTnI and IMA levels were included and after multivariate analysis,IMA （OR = 1.64,95% CI ： 1.2 - 2. 14, P = 0. 01 ） was an independent predictor of cardiac outcome. Conclusion IMA may be a useful biomarker for the identification of cardiac outcome in AMI patients presenting to hospital within 6 h of the onset of pain.