缺血修饰蛋白对心源性胸痛的临床诊断价值研究

The study of the difference of IMA between cardiac and non-cardiac chest pain patients

目的:探讨缺血修饰蛋白在心源性胸痛患者和非心源性胸痛患者的差异性,分析缺血修饰蛋白在早期心肌缺血的临床诊断价值。方法:按照胸痛发作时间,在到达急诊科即刻(胸痛发作3小时内)、6小时、24小时分别留取血标本,检测72例心源性胸痛患者及33例非心源性胸痛患者缺血修饰蛋白和肌钙蛋白I水平。分析心源性和非心源性胸痛患者中IMA水平的差异性,同时观察在心源性胸痛患者缺血修饰蛋白的变化趋势。运用ROC曲线,探索本实验室早期筛查心源性胸痛的白蛋白-钴结合试验(ACB)截断值。比较IMA与c Tn I对早期心肌缺血的临床诊断价值。结果:在首诊即刻(胸痛发生3小时内)和胸痛发作6小时,急诊心源性胸痛患者缺血修饰蛋白分别为71.3U/m L和75.7U/m L,高于非心源性胸痛组和健康对照组(<0.01)。动态观察心源性胸痛组缺血修饰蛋白水平变化:在胸痛发作3小时即可明显升高,在胸痛发作6小时仍上升,胸痛发作24小时回落至正常水平。缺血修饰蛋白ROC曲线下面积为0.853,当临界值取68.30U/m L,IMA的敏感性和特异性分别为80.67%和79.4%。在胸痛发作早期(小于3小时),与肌钙蛋白I相比,缺血修饰蛋白诊断缺血性胸痛的灵敏度高,分别为84.7%和65.26%。结论:缺血修饰蛋白作为心肌缺血的指标,可在胸痛发作早期,用于鉴别心源性胸痛和非心源性胸痛。IMA>68.3U/m L需考虑为心源性胸痛诊断。

Objective： This paper discusses the difference of ischemia modified albumin（IMA） between cardiac and non-cardiac chest pain patients.We analyses the clinical diagnostic value of IMA in early myocardial ischemia.Method： According to the chest pain time,the serum specimens were collected from 72 cardiac and 34non-cardiac chest pain patients were detected,which samples were obtained at when they arrived emergency department immediately（within 3 hours of onset of chest pain）,6 hours,24 hours after they are suffered chest pain.And serum IMA and c Tn I levels were observed respectively.To observe the difference of IMA between cardiac and non-cardiac chest pain patients and the level trend of IMA at the same time.Then we draw the ROC curve,try to determine the cutoff value of albumin-cobalt binding（ACB） of early screening cardiac chest pain.Try to compare the clinical diagnostic value of IMA and c Tn I in early diagnosis of myocardial ischemia.Results：IMA levels in patients with cardiac chest pain group when they immediately arrived at emergency department（within 3 hours of chest pain） and 6 hours are 71.3U/ml and 75.7U/ml respectively,higher than non-cardiac chest pain group and the healthy control group（P〉0.01）.Though dynamic observation,the IMA levels in patients with cardiac chest pain group could raise obviously in 3 hours after chest pain happened,higher after 6 hours,but drop on normal level within 24 hours.The area under ROC curve of IMA was 0.853,while the cutoff level is taken 68.30U/ml,with a sensitivity of80.67% and a specificity of 79.4%.In early time of cardiac chest pain（less than 3 hours）,the IMA diagnosis has higher sensitivity than c Tn I,which were 84.7% and 65.26%.Conclusion： IMA which is as an indicator of myocardial ischemia can be used to identify cardiac chest pain and non-cardiac chest pain in the early onset of chest pain.IMA〉68.3u/ml should be considered for the diagnosis of cardiac chest pain.