缺血修饰白蛋白在急性冠脉综合征早期诊断中的意义

Significance of ischemia modified albumin level in early diagnosis of acute coronary syndrome

目的：探讨缺血修饰白蛋白（IMA）在急性冠脉综合征（ACS）早期诊断中的意义。方法：收集急性冠脉综合征患者100例，非缺血性胸痛（NICP）患者132例，于胸痛发作4小时内采集静脉血，测定IMA、肌钙蛋白I （cTnI）肌红蛋白（Mb），入院即刻描记12导联心电图（ECG）。选择100名健康体检者作为对照组，采静脉血测定IMA。数据采用SPSS15.0进行统计学分析。结果：与健康体检组（57.6±4.1 U/ml）相比较， ACS组（85.5±10.3U/ml）、NICP组（70.1±9.8U/ml）的IMA水平差异有显著性（P〈0.01），ACS组与NICP组相比较差异有显著性（P〈0.01）。胸痛发作4小时内 IMA 与ECG、cTnI、Mb比较，可使ACS的诊断敏感性（χ^2=7.85,P〈0.005；χ^2=8.00,P〈0.005；χ^2=.23,P〈0.01）和阴性预测值（χ^2=3.03,P〈0.005；χ^2=7.92,P〈0.005；χ^2=.85,P〈0.05）显著提高。结论：在胸痛发生早期， IMA在ACS组显著升高，高于NICP组、健康体检组，可用于急性缺血引起胸痛的鉴别诊断；与ECG、cTnI、Mb相比IMA诊断早期ACS有更高的敏感性和阴性预测值，IMA＋cTnI＋ECG三者联合使用可提高急诊ACS诊断效率。

Objective：To explore the significance of ischemia modified albumin （IMA） in early diagnosis of acute coronary syndrome （ACS）.Methods：100 cases of patients with acute coronary syndrome （ACS） and 132 patients with non ischemic chest pain （NICP） were collected, respectively. Venous blood samples were collected within 4 hours after the onset of chest pain. IMA, myoglobin （Mb） and troponin-I （cTnI） were tested simultaneously. All the patients accepted 12-lead electrocardiogram （ECG） after admission immediately. 100 healthy people were selected as control group in which the IMA was also detected. SPSS15.0 was used to carry out statistical analysis.Results： Compared to the health group （57.6±4.1 U/ml）, the level of IMA in ACS group （85.5±10.3 U/ml） and NICP group （70.1±9.8 U/ml） is significantly different （P 〈 0.01）. There is significant difference between ACS group and NICP group （P 〈 0.01）. Within 4 hours of chest pain onset, the sensitivity and negative predictive value of IMA for diagnosis of ACS are significantly elevated compared with that of ECG（χ^2=57.85,P 〈 0.005;χ^2=13.03,P 〈 0.005） ,cTnI（χ^2=98.00,P〈 0.005;χ^2=17.92,P〈 0.005）and Mb（χ^2=.23 ,P〈0.01;χ^2=4.85 ,P〈0.05）.Conclusions：At early stage of chest pain, the level of IMA in ACS group is significantly higher than that of NICP group and control group. It can be used for the differential diagnosis of chest pain caused by acute ischemia. Combined with cTnI and ECG, the detection of IMA can improve the diagnosis efficiency of ACS.