IMA及cTnI在急性冠脉综合征早期诊断和近期预后评估中的价值

摘要

Objective: To explore early diagnostic and resent prognostic assessment value of serum levels of ischemia-modified albumin (IMA) and cardiac troponin I (cTnI) for acute coronary syndrome (ACS).Methods: A total of 175 ACS patients were selected, including 73 cases with unstable angina pectoris (UAP), 61 cases with non-ST elevation myocardial infarction (NSTEMI) and 41 cases with ST elevation myocardial infarction (STEMI).According to chest pain-to-visit time, ACS patients were divided into <3h group (n=112) and 3~6h group (n=63);another 40 healthy subjects were selected simultaneously as healthy control group.Serum IMA and cTnI levels were compared among above groups and between patients suffering from major adverse cardiovascular events (MACE) within 30d or not in <3h group.Risk factors for MACE in <3h patients within 30d were screened.Results: Compared with healthy control group and UAP group, there were significant rise in serum levels of IMA[(16.78±4.25) μg/L, (35.16±8.32) μg/L vs.(49.76±9.29) μg/L, (52.07±11.34) μg/L], cTnI[(0.17±0.06) ng/ml, (0.15±0.06) ng/ml vs.(7.65±1.29) ng/ml, (8.83±1.40) ng/ml]in NSTEMI group and STEMI group, and IMA level in STEMI group was significantly higher than that of NSTEMI group, that of UAP group was significantly higher than that of healthy control group (P<0.05 or <0.01);serum IMA level of <3h group was significantly higher than those of 3~6h group and healthy control group, and cTnI level of <3h group was significantly lower than that of 3~6h group (P<0.01 all);serum levels of cTnI and IMA in patients suffering from MACE in <3h group were significantly higher than those of patients without MACE (P<0.01 both);multi-factor Logistic regression analysis indicated that elevated serum IMA level was an independent risk factor for MACE within 30d in ACS patients[OR=2.757,95%CI(2.084~4.705), P=0.001].Conclusion: The levels of cTnI and IMA significantly rise in ACS patients.IMA level possesses early diagnosis and recent prognosis evaluation value.%目的:探讨血清缺血修饰白蛋白(IMA)、肌钙蛋白 I(cTnI)检测对急性冠脉综合征(ACS)早期诊断和近期预后评估的价值.方法:选择175例ACS患者,其中不稳定型心绞痛(UAP)73例、非ST段抬高型心肌梗死(NSTEMI)61例、ST段抬高型心肌梗死(STEMI)41例,ACS患者又根据胸痛就诊时间分为<3h组(112例)和3~6h组(63例);另选择同期健康体检者40例(健康对照组);比较各组间、<3h组30d内是否发生主要心脏不良事件(MACE)患者之间血清IMA、cTnI水平.筛选<3h组患者30d内发生MACE的危险因素.结果:与健康对照组和UAP组比较,NSTEMI组、STEMI组血清IMA[(16.78±4.25) μg/L、(35.16±8.32) μg/L比(49.76±9.29) μg/L、(52.07±11.34) μg/L]、cTnI[(0.17±0.06) ng/ml、(0.15±0.06) ng/ml比(7.65±1.29) ng/ml、(8.83±1.40) ng/ml]水平均明显升高,且IMA水平: STEMI组明显高于NSTEMI组,UAP组明显高于健康对照组(P<0.05或<0.01);<3h组血清IMA水平高于3~6h组和健康对照组,cTnI水平低于3~6h组(P均<0.01);<3h组发生MACE患者血清cTnI、IMA水平均显著高于未发生MACE患者(P均<0.01);多因素Logistic 回归分析显示血清IMA水平升高是ACS患者30d内发生MACE的危险因素[OR=2.757,95%CI(2.084~4.705), P=0.001].结论:ACS患者cTnI、IMA水平显著升高,IMA水平对于 ACS早期诊断和近期预后评估有重要价值.