缺血修饰白蛋白在急性冠状动脉综合征早期诊断中的应用价值研究

Study on the application significance of ischemia modified albumin in early diagnosis of acute coronary syndrome

目的观察急性冠状动脉综合征(ACS)患者血清缺血修饰白蛋白(IMA)水平的变化,探讨IMA在ACS早期诊断中的价值。方法连续监测97例ACS患者[包括急性心肌梗死(AMI)43例、不稳定型心绞痛(UAP)54例]急性胸痛发作后2、6、12、24、48 h血清IMA、肌酸激酶MB同工酶(CK-MB)和心肌肌钙蛋白T(c Tn T)水平的变化,并与42例疑似ACS最终确诊排除诊断的患者(对照组)比较;评价各项标志物在ACS早期诊断中的应用价值。结果 UAP及AMI患者发病后2 h血清IMA水平明显高于对照组(P<0.05),AMI患者发病12 h时达高峰,24 h时下降到和对照组水平基本持平。UAP患者CK-MB及c Tn T各检测时间点与对照组比较差异均无统计学意义(P>0.05)。受试者工作特征(ROC)曲线显示AMI患者发病2 h时,IMA、CK-MB、c Tn T诊断AMI的曲线下面积(AUC)分别为0.812、0.781、0.648。结论 IMA可作为ACS心肌缺血的敏感标志物,可用于早期诊断AMI。

Objective To observe the changes of ischemia modified albumin（ IMA） in patients with acute coronary syndrome（ ACS）,and investigate the application significance of IMA in early diagnosis of ACS. Methods The serum concentrations of IMA, MB isoenzyme of creatine kinase MB（ CK-MB） and cardiac troponin T（ cTnT） were continuously monitored at 2,6,12,24 and 48 h after onset in ACS patients with acute chest pain,including 43 cases of acute myocardial infarction（ AMI） and 54 cases of unstable angina pectoris（ UAP）,and were compared with 42 suspected cases of ACS（ control group）. Their applications for the early diagnosis of ACS were evaluated. Results IMA was higher in patients with UAP and AMI at 2 h after chest pain onset than healthy control group（ P〈0. 05）. The serum IMA reached a peak level at 12 h after the onset of chest pain and dropped to the same level as that of control group at 24 h. CK-MB and cTnT had no statistical significance in any determination time among the UAP patients.Receiver operating characteristic（ ROC） curves showed that the areas under the curve（ AUC） of IMA,CK-MB and cTnT were 0. 812,0. 781 and 0. 648,respectively at 2 h after chest pain onset. Conclusions IMA may be a sensitive biomarker for the myocardial ischemia of ACS patients,which can be used into the early diagnosis of AMI.