一过性冠状动脉痉挛时缺血修饰清蛋白水平的探讨

Investigation on ischemia modified albumin(IMA)level in transient myocardial ischemia induced by coronary vasospasm

目的探讨缺血修饰清蛋白(IMA)水平在一过性冠状动脉痉挛时是否会升高。方法血液样本为末梢动脉血,在患者接受操作前采一次血,在程序完成前或球囊膨胀后立即再采一次血。评价冠状动脉内麦角新碱马来酸盐激发痉挛试验的患者的IMA(n=36)水平;同时评价随机抽取的经皮冠状动脉介入治疗患者(n=17)和常规冠状动脉造影患者(n=11)的IMA水平。结果比起基准值,接受冠状动脉内麦角新碱马来酸盐激发试验阳性患者体内的IMA水平显著升高(P<0.000 1),而未接受激发试验的患者体内IMA水平没有改变(P=0.108)。经皮冠状动脉介入治疗后的患者体内清蛋白水平也升高了(P<0.000 1),常规冠状动脉造影患者的IMA水平没有变化(P=0.085)。激发试验后,发现在接受操作患者特征曲线的0.975置信区域内,当IMA升高大于9U/mL时可发现冠状动脉的痉挛存在,其灵敏度94%,特异性99%。所有患者的血清清蛋白水平都在正常参考值范围内,清蛋白、IMA的正常值、缺血后的IMA,三者之间没有明显关系。结论 IMA可以作为冠状动脉痉挛诱发的一过性心肌缺血的血清标志物。

Objective To explore whether the ischemia modified albumin will rise in transient myocardial ischemia.Methods Blood samples were taken from the arterial sheath before the procedure,and once more after procedural completion or balloon inflation.The level of ischemia-modified albumin in patients undergoing intracoronary ergonovine spasm provocation test（n=36） were detected.For additional comparison,ischemia-modified albumin level was also evaluated in elective percutaneous coronary intervention patients（n=17） and in patients with normal coronary angiography（n=11）.Results Median ischemia-modified albumin level was elevated significantly in patients with positive provocation test compared with baseline（P〈0.000 1）,whereas it did not change in patients with negative provocation test（P=0.108）.Ischemia-modified albumin level was also increased after percutaneous coronary intervention（P〈0.000 1）,and did not change in patients with normal coronary angiography（P=0.085）.Ischemia-modified albumin elevation higher than 9 U/ml after provocation test could detect the presence of coronary vasospasm,with an area under the receiver operating characteristic curve of 0.975,with a sensitivity of 94% and a specificity of 99%.Serum albumin levels were within reference range for all patients and there was no significant relationship among albumin,ischemia-modified albumin baseline and postischemic ischemia-modified albumin levels.Conclusion Ischemia-modified albumin may play a role as a biochemical marker for transient myocardial ischemia induced by coronary vasospasm.