缺血修饰蛋白在冠心病患者早期诊断中的应用研究  

Study on clinical meaning of ischemia modified albumin (IMA) in the early diagnosis of coronary heart disease

作　　者：戴天然 甘峰[1] 李茂荣[1] 王郑芳[1] 刘正湘[2] 

机构地区：[1]北京航天总医院,100076 [2]华中科技大学同济医学院

出　　处：《中国现代医药杂志》2010年第7期8-12,共5页Modern Medicine Journal of China

摘　　要：目的研究缺血修饰蛋白(IMA)在急性胸痛患者诊断中的临床意义。方法选择2006年1月至2008年11月期间我院心血管内科住院治疗的胸痛患者126例,分为非冠心病组(UCAD)33例,不稳定性心绞痛组(UAP)21例,急性心肌梗死组(AMI)72例。分别于入院后即刻、末次症状发作8h后、24h后抽取血液标本。测定血清中的IMA、cTnI、MYO,采用SPSS11.5统计软件包进行统计分析,各组间比较采用One Way ANOVA方差分析进行两两比较。结果入院即刻IMA值在UCAD组、UAP组和AMI组之间均存在统计学差异;末次症状8h后,AMI组IMA值仍与其他两组有统计学差异;末次症状24h后,三组患者所测IMA值之间均无统计学差异。126例患者中,有93例诊断为急性冠脉综合征(ACS),根据这93例检测所得IMA值绘制受者工作特征曲线(receive operating characteristic curve ROC),曲线下面积为0.896。当cutoff取值为1015μmol/L时,实验的敏感性和特异性之和最大,敏感性为0.917,特异性为0.778。IMA的诊断敏感性最高,为82.5%,ECG仅为29.9%,cTnI为43.2%,MYO为64.1%。不同判断指标的组合在入院后即刻诊断心源性疾病的阳性率为85.3%～93.8%。结论缺血修饰蛋白对急性胸痛患者的诊断具有一定价值。Objective To explore the clinical meaning of ischemia modified albumin(IMA) in the diagnosis of patients with acute chest pain. Methods 126 patients with chest pain who were hospitalized from Jan 2006 to Nov 2008 in our cardiology department. Blood sample were drown at entry,8 hours, 24 hours after last attacking, for the measurement of IMA,cTnI and MYO. Based on the diagnosis flowsheet and values of IMA,cTnI and MYO, of 126 chest pain patients, 33 were grouped into non-coronary heart disease(NCAD) group, 21 into unstable angina(UAP) group and 72 into acute myocardial infarction (AMI) group. Statistical analysis was done by SPSS 11.5 statistical package. One Way ANOVA was used to measure the differences between groups. Results The values of IMA at entry and 8 hour after last attacking in UCAD group were respectively different compared to the other groups (P0.05). The IMA ROC curve was drawn up according to the IMA value of 93 patients, who diagnosed as the heart source disease. When the cut off value was 1 015μmol/L, the sum of sensitivity (0.917) and peculiarity (0.778) was biggest. The sensitivity of IMA(82.5%) was higher than that of electrocardiogram(29.9%), cTnI(43.2%) and MYO (64.1%). The heart source disease’s immediate diagnosis positive rates of different judgment target combinations after in hospital were from 85.3% to 93.8%. Conclusion IMA is valuable for the diagnosis of patients with acute chest pain.

关 键 词：缺血修饰蛋白 急性冠脉综合征 

分 类 号：R541.4[医药卫生—心血管疾病]