血清缺血修饰白蛋白在冠心病患者中的临床应用价值

摘要

目的 探究血清缺血修饰白蛋白(isehemia modified albumin,IMA)在冠心病患者体内的变化及其与经皮冠状动脉介入治疗(PCI)术后再狭窄的关系,分析IMA在冠心病患者的早期诊断和PCI术后评估中的价值.方法 对疑似冠心病而收治入南京市第一医院的176例患者在入院后即行IMA检测,最终通过冠状动脉造影术确诊冠心病患者111例,非冠心病患者65例,比较两组之间血清IMA浓度有无显著差异,绘制IMA的受试者工作特征(ROC)曲线,分析IMA在ROC曲线下面积及IMA在诊断冠心病时的灵敏度和特异性.用同样的方法检测48例行PCI术治疗的患者术前IMA水平,半年后复查造影确定再狭窄患者7例,未发生再狭窄患者41例,采用t检验分析PCI术后再狭窄组与未再狭窄组患者IMA血清浓度的差别.结果 通过t检验分析发现,冠心病组IMA水平显著高于非冠心病组,差异具有统计学意义;通过绘制ROC曲线,IMA曲线下面积为0.88,其对冠心病诊断灵敏度和特异性可以分别达到88％和72％;在PCI术后再狭窄组和未再狭窄组中,两组患者术前IMA水平的差异无统计学意义(P＞0.05).结论 血清IMA作为近年来被确定的急性心肌缺血标志物,在冠心病的早期诊断中发挥着重要作用,将血清IMA作为冠心病的辅助诊断指标之一可以极大地降低冠心病患者的漏诊和误诊.血清IMA预测PCI术后患者是否发生血管内再狭窄尚需要大规模的临床研究.%Objective To study the significance of serum Ischemia Modified Albumin (IMA) level in patients with coronary heart disease and its relationship with restenosis after percutaneous coronary intervention therapy(PCI) in patients with coronary heart disease,also analyze the value of IMA in early diagnosis of coronary heart disease and in restenosis after PCI.Methods We measured IMA level of 176 patients admitted to the hospital with suspected coronary artery disease,simultaneously carrying on CysC,hs-CRP,electrocardiogram and other tests,also,coronary angiography confirms the final diagnosis of coronary artery disease.111 patients with coronary heart disease,65 patients without coronary heart disease were studied,by drawing IMA receiver operating characteristic (ROC) curve in diagnosis of coronary heart disease,to analyze the area under the curve,sensitivity and specificity.48 patients underwent PCI treated in the same way to detect IMA levels,by reviewing of angiographic after half year,we determined 7 patients with restenosis,41 patients without stenosis,then comparing the IMA level using t-test between patients with restenosis and patients without stenosis.Results The analyses of t-test showed that serum IMA levels of coronary heart disease group and non-coronary heart disease group were higher than the control group (P ＜ 0.05),and the IMA concentration of coronary heart disease group was higher than non-CHD group,the difference was statistically significant,by drawing ROC curve,the area under the curve is 0.88,and sensitivity and specificity of IMA can reach 88％ and 72％,there are no significant changes of the level of IMA between the patients without or with restenosis after PCI.Conclusion IMA has been identified in recent years as an acute myocardial ischemia marker,it plays an important role in the early diagnosis of coronary heart disease.The clinical application of IMA can greatly reduce misdiagnosis and missed diagnosis of coronary heart disease.But IMA level may not be associated with restenosis after PCI.