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Ischaemia-modified albumin: clinical utility and pitfalls in measurement

机译:缺血修饰的白蛋白:临床效用和测量中的陷阱

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摘要

Ischaemia occurs when there is a supply demand mismatch in cardiac blood flow. In unstable angina, this occurs due to partial or total occlusion of a coronary artery due to plaque rupture. In stable angina, there is progressive vascular occlusion resulting ultimately in a stenosis of more than 70%, impairing blood flow. Occasionally it may arise on a background of impaired blood flow and extreme oxygen demand. In this case, the area of myocardium affected will typically be one at the watershed of one or more arterial supplies. If the ischaemia is reversible, no myocardial damage occurs. If the ischaemia is prolonged there will be cellular necrosis and myocardial infarction. The interventional challenge for medicine is to be able to identify acutely impaired myocardial perfusion before necrosis has occurred. Currently, the only strategy for this is to detect ST segment changes on the ECG. Reperfusion therapy can then be initiated and is life-saving, and results in myocardial salvage. The majority of patients who present with chest pain do not have acute myocardial infarction (AMI). The sensitivity of the admission ECG is typically around 50%. There is therefore a need for a strategy that could detect ischaemia before necrosis occurs and result in prompt revascularisation. The challenge is to use additional quantitative risk stratification tools that could be biomarkers for ischaemia. Currently, three markers have been proposed: cho-line, free fatty acids and ischaemia-modified albumin (IMA). Of these, only IMA is currently available as a licensed test for routine clinical application.
机译:当心脏血流中供需不匹配时,发生缺血。在不稳定型心绞痛中,这是由于斑块破裂导致冠状动脉部分或全部阻塞所致。在稳定型心绞痛中,进行性血管闭塞最终导致狭窄超过70%,从而损害了血流。有时可能是由于血流受损和氧气需求过高而引起的。在这种情况下,受影响的心肌面积通常将是一个或多个动脉供应的分水岭。如果局部缺血是可逆的,则不会发生心肌损伤。如果局部缺血时间延长,将会出现细胞坏死和心肌梗塞。医学上的介入挑战是要能够在坏死发生之前识别出严重受损的心肌灌注。当前,唯一的策略是检测ECG上ST段的变化。然后可以开始再灌注治疗,这种方法可以挽救生命,并挽救心肌。表现出胸痛的大多数患者没有急性心肌梗塞(AMI)。入院心电图的敏感性通常约为50%。因此,需要一种能够在坏死发生之前检测出局部缺血并导致迅速血运重建的策略。面临的挑战是使用其他可能成为缺血性生物标志物的定量风险分层工具。当前,已经提出了三种标记:胆碱,游离脂肪酸和缺血修饰的白蛋白(IMA)。其中,目前只有IMA作为常规临床应用的许可测试可用。

著录项

  • 来源
    《Journal of Clinical Pathology》 |2008年第9期|p.1025-1028|共4页
  • 作者

    P O Collinson; D C Gaze;

  • 作者单位

    Department of Chemical Pathology, St George's Hospital and Medical School, Blackshaw Road, London SW17 OQT, UK;

  • 收录信息 美国《科学引文索引》(SCI);美国《化学文摘》(CA);
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 病理学;
  • 关键词

  • 入库时间 2022-08-18 01:37:37

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