缺血修饰白蛋白在急性冠状动脉综合征早期诊断的应用研究

摘要

目的：探讨缺血修饰白蛋白（IMA）诊断早期急性冠状动脉综合征（ACS）的价值。方法分别测定68例健康者（对照组）、78例 ACS 患者[其中不稳定型心绞痛（UA）患者55例，急性心肌梗死（AMI）患者23例]发病3 h、6 h 的血清IMA、肌钙蛋白 I（cTnI）、肌酸激酶同工酶（CK－MB）水平；分析 IMA、cTnI、CK－MB 诊断 ACS 的效能。结果UA、AMI 组发病3 h、6 h 时血清 IMA 水平与对照组比较，差异均有统计学意义（P ＜0．05）；两组发病3 h、6 h 血清 IMA 水平明显高于对照组（P ＜0．05）。 UA、AMI 组发病3 h 时血清 cTnI、CK－MB 水平与对照组比较，差异无统计学意义（P ＞0．05），但6 h 血清cTnI、CK－MB水平明显高于对照组（P ＜0．05）。3 h 时 IMA 诊断 ACS 的灵敏度、特异度分别为84．6％、80．9％，cTnI 分别为7．7％、92．6％，CK－MB 分别为10．3％、86．8％，IMA、cTnI、CK－MB 3项指标联合诊断的灵敏度、特异度分别为85．9％、97．1％。6 h时IMA 诊断 ACS 的灵敏度、特异度分别为76．9％、83．8％，cTnI 分别为38．5％、97．1％，CK－MB 分别为44．9％、92．6％，IMA、cTnI、CK－MB 3项指标联合诊断的灵敏度、特异度分别为94．9％、98．5％。结论血清 IMA 水平可作为 ACS 患者早期心肌缺血诊断的灵敏指标，IMA、cTnI、CK－MB 联合检测可提高诊断效能。%Objective To investigate the value of ischemia modified albumin(IMA) in the early diagnosis of acute coronary syndrome (ACS).Methods The serum levels of IMA,cardiac troponin I(cTnI) and creatine kinase isoenzyme MB(CK-MB) were determined in 68 healthy controls(control group) and 78 patients with ACS including 55 with unstable angina(UA) and 23 with acute myocardial infarction(AMI) 3 and 6 hours after ACS attack.And their value in the early diagnosis of ACS was assessed.Results There was significant difference in the serum levels of IMA between UA or AMI group 3 and 6 hours after ACS attack and the control(P <0.05).The serum levels of IMA in both AMI and UA groups were significantly higher than those in the control group 3 and 6 hours after ACS attack(P <0.05).The serum levels of cTnI or CK-MB showed no significant difference between UA or AMI group 3 hours after ACS attack and the control(P >0.05), while the serum levels of cTnI and CK-MB of UA and AMI groups were significantly higher than those of control group 6 hours after ACS attack(P <0.05).The sensitivities of IMA,cTnI and CK-MB for diagnosis of ACS 3 hours after ACS attack were 84.6%,7.7% and 10.3%,respectively,while the specificities were 80.9%,92.6% and 86.8%,respectively;the sensitivity and specificity of combined detection(IMA,cTnI and CK-MB) were 85.9% and 97.1%,respectively.The sensitivities of IMA,cTnI and CK-MB for diagnosis of ACS 6 hours after ACS attack were 76.9%,38.5% and 44.9%,respectively,while the specificities were 83.8%,97.1% and 92.6%,respectively;the sensitivity and specificity of combined detection(IMA,cTnI and CK-MB) were 94.9% and 98.5%,respectively.Conclusion The serum level of IMA can act as an sensitive index of early diagnosis of myocardial ischemia.The combined detection of IMA,cTnI and CK-MB might increase the diagnostic accuracy for ACS patients.