经皮冠状动脉球囊置入后冠状动脉粥样硬化性心脏病患者缺血修饰白蛋白的检测及意义  

Detection and significance of ischemia modified albumin changes in patients with coronary atherosclerotic heart disease following percutaneous coronary intervention

作　　者：黄惠芳[1] 陆荣 黄杏梅[3] 顾国浩[1] 

机构地区：[1]苏州大学附属第一医院检验科,江苏省临床免疫学实验室,江苏省苏州市215006 [2]苏州市100医院检验科,江苏省苏州市215006 [3]苏州大学附属第一医院心内科,江苏省苏州市215006

出　　处：《中国组织工程研究与临床康复》2009年第22期4257-4260,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：江苏省临床免疫学重点实验室基金资助项目(200319)~~

摘　　要：背景：最近发现缺血修饰白蛋白诊断心肌缺血的敏感性很高,能在心肌缺血早期可逆阶段被检出,是第一个被FDA批准销售的心肌缺血标志物。目的：探讨冠状动脉粥样硬化性心脏病患者经皮冠状动脉球囊置入后冠状动脉粥样硬化性心脏病患者缺血修饰白蛋白的水平变化及其临床意义。设计、时间及地点：病例-对照观察,试验于2007-11/2008-03在苏州大学附属第一医院检验科实验室完成。对象：选择苏州大学附属第一医院心内科住院确诊为冠状动脉粥样硬化性心脏病并行择期经皮冠状动脉球囊置入治疗的患者46例,男35例,女11例,年龄34～81岁;另选苏州大学附属第一医院体检健康人群60名作为对照,男36名,女24名,年龄42～75岁。方法：测定60名体检健康者和46例冠状动脉粥样硬化性心脏病患者术前与术后5min,术后2,6h血清中缺血修饰白蛋白的水平;46例择期经皮冠状动脉球囊置入治疗的患者,于球囊扩张后5min,2,6h取静脉血2mL进行心肌肌钙蛋白T测定,测定值〉0.16μg/L者判为阳性。主要观察指标：血清中缺血修饰白蛋白及心肌肌钙蛋白T的水平。结果：行经皮冠状动脉球囊置入治疗后5min、术后2h缺血修饰白蛋白水平较术前及对照组升高（P〈0.01）;术前与术后6h相比,差异无显著性意义（P〉0.05）。在行经皮冠状动脉球囊置入治疗后5min、术后2h46例患者心肌肌钙蛋白T均为阴性,术后6h有3例患者心肌肌钙蛋白T阳性。结论：心肌缺血患者血清中缺血修饰白蛋白水平升高较心肌肌钙蛋白T出现早,缺血修饰白蛋白可作为心肌缺血发生后到发生细胞坏死之前的一个早期指标。BACKGROUND： Recent evidence indicates that ischemia modified albumin （IMA） is highly sensitive to myocardial ischemia to detect early myocardial ischemia at reversible stage. It is the marker of myocardial ischemia firstly approved by FDA to be sold. OBJECTIVE： To investigate the tMA changes and its ctinical significance in patients with coronary atherosclerotic heart disease fottowing percutaneous coronary intervention （PCt）. DESIGN, TIME AND SETTING： Case-contrast observation. The experiment was performed at the Department of Clinical Laboratory, First Affiliated Hospital of Soochow University between November 2007 and March 2008. PARTICIPANTS： A total of 46 patients with coronary atherosclerotic heart disease were treated with PCI in First Affiliated Hospital of Soochow University, including 35 males and 11 females, aged 34 to 81 years old. In addition, 60 healthy persons were selected as control, including 36 males and 24 females, aged 42 to 75 years old. METHODS： Serum content of IMA in 60 controts and 46 patients were measured before and 5 minutes, 2 and 6 hours after PCL In addition, 2 mL venous blood was drawn from 46 patients 5 minutes, 2 and 6 hours after PCI cardiac to determine cardiac troponin （cTnT） volume, cTnT volume 〉 0.16 μg/L was regarded as positive. MAIN OUTCOME MEASURES： IMA and cTnT contents. RESULTS： At 5 minutes, 2 hours after PCI, fMA levels was significantly increased compared with before PCf and control group （P 〈 0.01 ）, but similar to 6 hours after PCI （P 〉 0.05）. At 5 minutes, 2 hours after PCI, 46 patients were negative for cTnT. However, 3 cases were positive for cTnT 6 hours after PCI. CONCLUSION： in patients with myocardial ischemia, IMA tevels in serum is earlier increased than cTnT, therefore, tMA could be regarded as early index to monitor myocardial ischemia before the occurrence of cell necrosis.

关 键 词：心肌缺血 缺血修饰白蛋白 肌钙蛋白 

分 类 号：R541.4[医药卫生—心血管疾病]