缺血修饰白蛋白在急性冠状动脉综合征筛查中的价值

Value of ischemia-modified albumin for screening acute coronary syndrome

目的:探究全血缺血修饰白蛋白(ischemia-modified albumin,IMA)检测在急诊首次快速筛查中,是否能为快速识别急性冠状动脉综合征(acute coronary syndrome,ACS)提供依据。方法:对我院急诊有胸痛等相关主诉的105例患者行12导联心电图检查及肌钙蛋白I(troponin I,TNI)、全血IMA的筛查。绘制IMA的受试者工作特征(receiver operating characteristic,ROC)曲线,探索其界限值,并将结果与依据世界卫生组织诊断标准所得的结果相对比。结果:105例患者中确诊为ACS病例者共28例,IMA平均值为(162.6±47.0)u/m L;77例非ACS病例的IMA平均值为(139.0±48.2)u/m L。IMA检测的ROC曲线下面积为0.632,界限值为120.8 u/m L。由此所得,IMA诊断ACS的灵敏度为75.00%,特异度为44.16%,阳性预测值为82.93%。IMA联合TNI或12导联心电图检测时,灵敏度可升高至92.86%和100%,特异度分别为32.47%和44.16%,IMA联合12导联心电图时阴性预测值可达100%。结论 :IMA单独作为急诊筛查ACS指标的应用价值不高,但其联合肌钙蛋白I或12导联心电图检查则可显著提高诊断的灵敏度;IMA联合12导联心电图筛查为阴性者,可基本可排除ACS。

Objective： To investigate the value of ischemia-modified albumin（IMA） in rapid screening of acute coronary syndrome（ACS） at emergency department. Methods： A total of 105 cases attending our emergency center for chief complaint of acute chest pain were enrolled. All patients received rapid screening by 12 lead electrocardiograph（ECG）,troponin I（TNI）and IMA. The cutoff value of IMA was calculated by the receiver operating characteristic（ROC） curve analysis, and was compared with the gold standard published by WHO. Results： Twenty-eight of the 105 cases were diagnosed as ACS, the mean IMA value was（162.6±47.0） u/m L. The IMA value for non-ACS patients（77/105） was（139.0±48.2） u/m L. The area under ROC curve was 0.632, cut-off value was 120.8 u/L. The sensitivity of IMA for diagnosing ACS was 75.00%, and the specificity was 44.16%, positive predictive value（PPV） was 82.93%. When combined with TNI, the sensitivity and specificity of IMA for diagnosing ACS were 92.86% and 32.47%, respectively. When combined with EKG,sensitivity and specificity of IMA for diagnosing ACS were 100% and 44.16%, respectively, while negative predictive value（NPV） was 100%. Conclusions： The value of IMA alone is not high enough for screening ACS. When combined with EKG or TNI, sensitivity for diagnosing ACS increases markedly. ACS could be excluded when the combined IMA and EKG showing negative results.