缺血修饰白蛋白在急性心肌缺血早期诊断中的临床价值

Clinical significance of ischemia modified albumin in early diagnosis of acute cardiac ischemia

目的 探讨血清缺血修饰白蛋白（ischemiamodifiedalbumin，IMA）检测在急性心肌缺血早期诊断中的临床价值。方法收集80例急性冠状动脉综合征（acutecoronarysyndrome，ACS）患者及60例确诊为非缺血性心脏病患者，采用间接白蛋白钴结合试验（albumincobaltbindingtest，ACB）检测受试者胸痛发作3h内的血清IMA水平，同时检测患者心肌肌钙蛋白T（cardiactroponinT，cTnT）、肌酸激酶同工酶（creatinekinaseisoenzymeMB，CK—MB）水平。通过受试者工作特征（receiveroperatingcharacter—istic．ROC）曲线判定IMA用于诊断ACS的最佳临界值，确定IMA诊断ACS的敏感度、特异性、阳性预测值和阴性预测值。结果与对照组比较，ACS组ACB值明显降低，且两组间比较差异具有统计学意义（P〈0．01），而两组间cTnT、CK—MB水平差异均无统计学意义（P均〉0．05）。急性心肌梗死组与不稳定型心绞痛组间ACB值比较差异无统计学意义（P〉0．05）。根据ROC曲线，当cut—off值为63．60U／mL时，IMA检测ACS的敏感度、特异性、阳性预测值和阴性预测值均较高，分别为81．27％、86．58％、84．19％和82．57％。结论IMA是早期诊断心肌缺血的敏感标志物．对于ACS的早期诊断和治疗具有重要的临床意义。

Objective To discuss the clinical significance of ischemia modified albumin（IMA） in early diagnosis of acute cardiac ischemia. Methods 80 cases of patients with acute coronary syndrome （ACS） and 60 cases of patients with chest pain while finally diagnosed as non-ischemic heart diseases were collected. The level of IMA were detected by indirect albumin cobalt binding test （ACB） within 3 h after the chest pain attacked. The levels of cardiac troponin T （cTnT） and creatine kinase isoenzyme MB （CK-MB） were measured at the same time. The optimal cut-off value was decided by drawing receiver operating characteristic （ROC） curve of ACB value and then the sensitivity, specificity, positive predictive value and negative predictive value of AMI in diagnosis of ACS were determined. Results Compared to the control group, ACB value of ACS group was significantly lower, and there was statistical significance in the difference between the two groups （P〈 0.01）. There were no statistical significance in the differences of cTnT and CK-MB between control group and ACS group（Pall〉 0.05）. While there was no statistical significance in ACB value between acute myocardial infarction group and unstable angina group （/9〉 0.05）. According to ROC curve, when the cut-off value was 63.60U/mL, the sensitivity, specificity, positive predictive value and negative predictive value of IMA in ACS diagnosis were relatively high, as 81.27%, 86.58%, 84.19% and 82.57% respectively. Conclusion IMA is the sensitive marker for the early diagnosis of cardiac ischemia, and with the important clinical significance for the early diagnosis and cure of ACS.