缺血修饰白蛋白对非ST段抬高型急性冠状动脉综合征患者诊断及危险分层的评价研究

Evaluation of ischemia modified albumin in the diagnosis and prognosis of patients with non-ST-segment elevation acute coronary syndrome

目的：研究新型心肌缺血标志物缺血修饰白蛋白在非ST段抬高急性冠脉综合征患者的血清水平，探讨缺血修饰白蛋白水平对非ST段抬高急性冠脉综合征患者的疾病诊断、危险分层中的价值。方法：收集非ST段抬高急性冠脉综合征患者137例（其中非ST段抬高型心肌梗死患者73例，不稳定型心绞痛患者64例），并以120例急性心肌缺血者作为对照（其中稳定型心绞痛患者37例，冠状动脉粥样硬化患者43例，健康者40例），采集肌钙蛋白指标及GRACE评分，并对所有入院患者采用酶联免疫吸附试验方法检测缺血修饰白蛋白值，对结果进行统计学分析。结果：①非ST段抬高型心肌梗死患者缺血修饰白蛋白平均水平（118.02±38.14，U/ml），不稳定型心绞痛患者缺血修饰白蛋白平均水平（121.34±53.73，U/ml），稳定型心绞痛患者缺血修饰白蛋白平均水平（95.03±32.78，U/ml），冠状动脉粥样硬化患者缺血修饰白蛋白平均水平（101.65±30.04，U/ml），健康人群缺血修饰白蛋白平均水平（71.87±10.86，U/ml），五组中不稳定型心绞痛患者血清缺血修饰白蛋白平均水平最高，非ST段抬高型心肌梗死患者的缺血修饰白蛋白水平高于稳定型心绞痛患者，差异有统计学意义，不稳定型心绞痛患者的缺血修饰白蛋白水平高于稳定型心绞痛患者，差异有统计学意义；②非ST段抬高型心肌梗死和不稳定型心绞痛患者缺血修饰白蛋白水平与GRACE评分相关性；③非ST段抬高型心肌梗死和不稳定型心绞痛患者术前、术后24小时内和出院前血清缺血修饰白蛋白水平差异；④非ST段抬高型心肌梗死和不稳定型心绞痛患者的缺血修饰白蛋白水平与肌钙蛋白I相关性；⑤血清缺血修饰白蛋白用于诊断非ST段抬高急性冠脉综合征的ROC曲线敏感度为68.7%，特异度为60%，曲线下面积为0.641，血清缺血修饰白蛋白诊断非ST段抬高急性冠脉综合征准确性较低。结论：非ST段抬高急性冠脉综合征患者新型心肌缺血标志物血清缺血修饰白蛋白的表达水平高于稳定型心绞痛患者；非ST段抬高型心肌梗死和不稳定型心绞痛患者的缺血修饰白蛋白水平区别；缺血修饰白蛋白水平诊断非ST段抬高急性冠脉综合征准确性较低，目前不能还作为非ST段抬高急性冠脉综合征患者的危险分层的指标。

Objective To study the serum level of ischemia modified albumin in patients with non ST segment elevation acute coronary syndrome, and to explore the value of ischemia modified albumin in the diagnosis and risk stratification of patients with non ST segment elevation acute coronary syndrome. Methods 137 cases of patients with non-ST-elevation elevation acute coronary syndrome（including 73 cases of non-ST-elevation myocardial infarction, 64 cases of unstable angina patients） were included, and 120 cases of non acute myocardial ischemia（including 37 cases of stable angina pectoris, 43 cases of coronary arteriosclerosis, 40 cases of healthy population） were collected. Patient′s troponin I and GRACE score were colllected. And all patients were detected ischemia modified albumin values by enzyme-linked immunosorbent assay method. The results were statistically analyzed. Results ⑴Level of IMA：NSTEMI patients（118.02±38.14）U/ml, UAP patients （121.34±53.73）U/ml, SAP patients（95.03±32.78）U/ml, coronary arteriosclerosis patients（101.65±30.04）U/ml, healthy population（71.87±10.86）U/ml. Between the five groups, unstable angina patients with serum ischemia modified albumin the highest level. The level of IMA in NSTEMI patients was higher than that in SAP patients（P〈0.05）. The level of IMA in UAP patients was higher than that in SAP patients（P〈0.05）. ⑵The level of IMA in NSTEACS patients was not correlated with GRACE score. ⑶The level of IMA in NSTEACS patients was no difference between preoperative, postoperative and before discharged. ⑷IMA for the diagnosis of NSTEACS ROC curve sensitivity of 68.7%, specificity of 60%, the area under the curve of 0.641, IMA diagnosis of NSTEACS is less accurate. Conclusion The expression of IMA in NSTEACS patients was higher than that in SAP patients. There was no difference in IMA levels between patients with NSTEMI patients and UAP patients. IMA levels are less accurate in the diagnosis of NSTEACS patients and are currently not yet used as a risk stratification marker for patients with non-ST-segment elevation acute coronary syndromes.