缺血修饰清蛋白在急性冠状动脉综合征心肌缺血早期诊断中的应用

The application of ischemia-modified albumin in the early diagnosis of myocardial ischemia of acute coronary syndrome

目的探讨缺血修饰清蛋白(IMA)在急性冠状动脉综合症(ACS)心肌缺血早期诊断中的应用价值。方法选择2008年1月至2010年6月本院ACS患者88例为ACS组,非缺血性胸痛(NICP)50例为NICP组,本院同期体检健康者40例为对照组,采用蛋白钴结合试验(ACB试验)检测3组患者血清IMA水平(ACB值)及cTnI浓度。结果 ACS组ACB水平[(61.73±11.2)U/mL]明显低于NICP组(75.5±8.1)U/mL)与对照组[(81.3±6.1)U/mL),P<0.05];ACS组cTnI血清水平与NICP组比较,差异无统计学意义(P>0.05);通过受试者工作特征(ROC)曲线分析,ACB水平的合适诊断界值为70.0 U/mL,诊断急性心肌缺血的敏感性为84.1%,特异性为80.0%,ROC曲线下面积(AUC)为0.919(95%的置信区间为0.862～0.976)。结论 IMA是ACS急性心肌缺血早期诊断的敏感标志物,具有重要的阴性预测价值。

Objective To investigate the application of ischemia modified albumin （IMA）in the early diagnosis of myocardial ischemia of acute coronary syndrome（ACS）. Methods 88 cases of ACS were selected as the ACS group, 50 cases With NICP. And 40 normal cases included in the healthy controts All of the cases were from January 2008 to June 2011 in our hospital. Serum IMA and cTnI were measured by albumin cobalt binding（ACB）test. Results The levels of ACB in patients with ACS（61.73±11.2）U/mL） was significantly lower than that in NICP（75.5 ± 8.1）1U/mL）and healthy controls（81.3 ± 6.1 ）U/mL）. P〈0.05. The levels of cTnI in patients with ACS and NICP was not a obvious distinction（P〉0.05）, there was not a obvious distinction of ACB values among three groups of ACS（P〉0.05）. The optimum diagnostic cut-off value for ACB level was 70.0 U/mL by receiver operating characteristic（ROC） curve analysis. The sensitivity was 84.1%, the specificity was 80.0 %. The area under ROC curve （AUC）was 0.919 （95 % confidence interval 0. 862-0.976）. The positive predictive value was 88.1%, and the negative predictive value 74.1%. The diagnostic accuracy was 82.6%. Conclusion IMA is a sensitive marker in the early diagnosis acute myocardial ischemia of ACS,and a very important value for negative predictive of ACS.