缺血修饰白蛋白和半乳糖凝集素-3联合检测在急诊胸痛患者中的应用价值

Application value of combined detection of ischemia modified albumin and galectin-3 in emergency chest pain patients

目的研究血清缺血修饰白蛋白(IMA)、半乳糖凝集素-3(Gal-3)联合检测在急诊胸痛患者中的应用价值。方法选择2016年12月至2017年92例急诊胸痛疑似急性冠脉综合征(ACS)住院患者,在胸痛发作2 h内留取血样采用酶联免疫吸附法(ELISA)测定IMA、Gal-3含量,结合冠脉造影和冠脉内超声结果,将患者分为三组:ACS组(n=38),稳定型心绞痛(SAP)组(n=28),非冠心病(NCHD)组(n=26),分别比较各组IMA、Gal-3含量的差异,并观察IMA、Gal-3联合检测对ACS、SAP的诊断价值。结果 ACS组IMA、Gal-3水平均明显高于SAP组和NCHD组(P<0.01)。SAP组的IMA水平高于NCHD组(P<0.05),Gal-3水平与NCHD组差异无统计学意义(P>0.05)。IMA、Gal-3联合检测对诊断冠心病有较高的敏感性、特异性、阳性预测值、阴性预测值,明显高于心电图、IMA、Gal-3任何一项单独检测的价值(P<0.05)。结论联合检测IMA、Gal-3可以提高急诊胸痛患者冠心病诊断的准确率,在传统心肌坏死标志物升高之前对ACS有较高的筛选价值,有助于ACS、SAP、NCHD之间的鉴别,从而达到及时对胸痛患者进行分诊处理和危险分层。

Objective To investigate the application value of combined detection of serum ischemia modified albumin(IMA) and galectin-3(Gal-3) in emergency patients with chest pain.Methods Ninety-two hospitalized patients with emergency chest pain suspected acute coronary syndrome(ACS) were selected.The blood specimens were collected within 2 hours of chest pain attack,and the contents of serum IMA and Gal-3 were measured by enzyme linked immunosorbent assay(ELISA).The patients were divided into 3 groups according to the results of ELISA combined with coronary angiography and intracoronary ultrasound:ACS group(n=38),stable angina pectoris(SAP) group(n=28) and non-coronal heart disease(NCHD) group(n=26).Level of serum IMA and Gal-3 were compared in three groups.The diagnostic value of combined detection of IMA and Gal-3 for ACS and SAP was observed.Results The levels of serum IMA and Gal-3 in ACS group were significantly higher than those in SAP group and NCHD group(all P<0.01).The level of serum IMA in SAP group was significantly higher than that in NCHD group(P<0.05),while there was no significant difference in the level of serum Gal-3 between the two groups(P>0.05).The sensitivity,specificity,positive prediction value and negative prediction value of combined detection of IMA and Gal-3 were significantly higher than those for any single test of electrocardiogram,IMA and Gal-3(all P<0.05).Conclusion The combined detection of IMA and galectin-3 can improve the accuracy rate of diagnosis of coronary heart disease with emergency chest pain and have higher screening value for ACS before the increase of traditional markers of myocardial necrosis.Their combined detection can help to identify ACS,SAP and NCHD so as to achieve timely diagnosis and risk stratification for patients with chest pain.