人缺血修饰白蛋白对糖尿病合并冠心病早期诊断及其预后的价值分析

The value analysis of ischemia modified albumin in early diagnosis and prognosis of diabetes combined with coronary heart disease

目的探讨治疗前人缺血修饰白蛋白(ischemia modified albumin,IMA)水平在预测冠心病病情程度中的作用,并分析其与冠心病预后及心血管事件发生之间的关系。方法选取南京医科大学附属无锡市人民医院2010年11月～2011年5月收治的患者88例,分为糖尿病合并急性冠脉综合征(acute coronary syndrome,ACS)急性发作组(ACS组)、糖尿病合并稳定性心绞痛(stable angina pectoris,SAP)组(SAP组)、仅有糖尿病而无冠心病组(无冠心病组)。收集患者的一般临床资料,应用ELISA方法测定所有患者血清中IMA含量。结果 ACS组中血清IMA的含量为(37.5±21.3)U/mL,SAP组为(27.4±16.3)U/mL,两组比较,差异有统计学意义(t=2.651,P<0.05),无冠心病组为(20.0±11.4)U/mL,与ACS组比较,差异有统计学意义(t=7.253,P<0.05),SAP组血清IMA含量与无冠心病组相比无显著增高,两组比较,差异无统计学意义(t=1.008,P>0.05)。人血清IMA含量与肌酸激酶、乳酸脱氢酶、LVEF值无相关关系。人血清IMA含量与入院即刻血糖、hsCRP、肌酸激酶同工酶、门冬氨酸氨基转移酶呈正相关,与入院血压呈负相关。半年随访发生心血管事件患者的IMA水平[(40.29±25.89)U/mL]明显高于未发生心血管事件患者的IMA水平[(29.48±17.70)U/mL],两者比较,差异有统计学意义(P=0.014)。结论人血清IMA检测在冠心病严重程度及预后评估中具有重要的价值,可以作为冠心病早期诊断的生化指标之一;人血清IMA的升高程度与预后及心血管事件之间有一定的关系,可以作为反映病情的一个重要的实验室指标。

Objective To discuss the effect of ischemia modified albumin（IMA） testing for coronary heart disease（CHD） detection,and to analyze the relationship between IMA and coronary heart disease prognosis,cardiovascular events.Methods 88 cases of patients were collected from November 2010 to May 2011 in the People＇s Hospital of Wuxi City Affiliated to Nanjing Medical University,and the patients were divided into diabetes combined with acute coronary syndrome（ACS）（ACS group）,diabetes combined with stable angina pectoris（SAP）（SAP group）,and diabetes combined without coronary heart disease（no CHD）（no CHD group）.The clinical data of the patients were collected.IMA content in serum was detected by ELISA technology.Results IMA content of the patients in ACS group was（37.5±21.3）U/mL while in SAP group was（27.4±16.3）U/mL,there was a significant difference between two groups（t=2.651,P0.05）.Meanwhile,IMA content of patients in no CHD group was（20.0±11.4）U/mL,there was a significant difference between ACS group and no CHD group（t=7.253,P0.05）.There was no significant increase in IMA content observed between SAP group and no CHD group（t=1.008,P0.05）.There was no clear correlation between IMA content in serum and level of Creatine Kinase（CK）, lactate dehydrogenase（LDH）,LVEF.Positive correlation observed between IMA content and level of admission blood glucose,hsCRP,creatine kinase isoenzymes（CK-MB）,glutamic-oxaloacetic transaminase（AST）.Negative correlation observed between IMA content and level of admission blood pressure.In a six-months follow-up IMA content for patients with cardiovascular events [（40.29±25.89）U/mL] was significantly higher than those of the patients without cardiovascular envents [（29.48 ±17.70）U/mL]（P=0.014）.Conclusion IMA testing is of great value for CHD patients in terms of evaluation of severity and prognosis.It can be used as diagnostic index for CHD in early stage.Level of IMA content is correlated to CHD driven cardiovascular events,thus can be used as one important laboratory index showing patients＇ condition.