缺血修饰白蛋白在心肌缺血早期诊断中的临床价值  

Clinical significance of ischemia modified albumin in early diagnosis of cardiac ischemia

作　　者：李志远 郭红前 贾意国 刘元勋 李敏 杨曙光[2] 

机构地区：[1]山东省泰山医院心内科,山东泰安271000 [2]中国人民解放军第88医院心内科,山东泰安271000

出　　处：《泰山医学院学报》2010年第9期656-658,共3页Journal of Taishan Medical College

摘　　要：目的探讨缺血修饰白蛋白(IMA)对心肌缺血的早期诊断价值。方法30例急性冠状动脉综合征(ACS)患者在胸痛发作3 h内取血测定ACB值、肌钙蛋白T(cTnT)并在入院后即刻描记18导联心电图(ECG),同时选择30例稳定性冠状动脉疾病患者、30例健康查体者为对照,经受试者工作特征曲线分析获得区分健康者与心肌缺血者ACB值最适截断值。ACB值、cTnT及ECG结果分别与最终诊断结果进行综合分析,评价其诊断ACS敏感性。结果ACS组、稳定性冠状动脉疾病组ACB值分别为(76.50±8.44)U/ml和(85.77±8.40)U/ml,低于健康对照组(98.73±3.44)U/ml,三者差异有统计学意义(P<0.001),且组间两两比较差异均有统计学意义(P<0.05)。三组cTnT浓度无明显升高,组间比较差异无统计学意义(P>0.05)。心肌缺血者(含ACS组及稳定性冠状动脉疾病组)与正常对照分析,ACB值ROC曲线下面积0.976,在截断值为93U/ml时诊断心肌缺血的敏感性和特异性分别为86.67%,96.67%,诊断的阳性似然比为26.0,阴性似然比为0.14,阳性预测值为98.1%,阴性预测值为78.4%。而同时ECG、cTnT诊断心肌缺血的敏感性分别为66.67%、16.67%,IMA指标(ACB值)诊断早期心肌缺血的敏感性优于ECG和cTnT。结论IMA在心肌缺血的早期诊断中具有重要的临床价值。Objective： To investigate the early diagnostic value of ischemia modified albumin（IMA） for cardiac ischemia.Methods：IMA levels were detected by albumin-cobalt binding test（ACB value）.Thirty patients with ACS within 3 hours of acute chest pain were included.Thirty patents with stable coronary heart diseases and 30 healthy controls were included.On admission,a18-lead electrocardiogram（ECG） was recorded and blood samples were taken for IMA and cardiac troponin T（cTnT） measurement.Patients underwent standardized triage,diagnostic procedures and treatment.Receiver operating characteristic curve（ROC） analysis was used to determine the optimal cutoff value of this assay for identifying individuals with cardiac ischemia from normal individuals.Results： We compared the ACB value of patients with acute coronary syndrome with those of patients with stable coronary artery disease and those of normal individuals and found them to be significantly lower in the first and second group（P〈0.001）.The ACB value of in ACS group（76.50±8.44）U/ml was significant lower than that in stable coronary heart disease（85.77±8.40）U/ml（P〈0.05）.And the concentration of cTnT in the 3 groups had no significant difference.A cutoff value of ACB value of 93U/ml was found by using receiver operating characteristic curve analysis.The sensitivity and specificity of this cutoff value to identify the patients of cardiac ischemia were found to be 86.67%（95%CI 75.40,94.0）and 96.67%（95%CI 82.70,99.40）,respectively.Positive likelihood ratio and negative likelihood ratio of IMA for cardiac ischemia were 26.00（95%CI 23.1,29.3） and 0.14（95%CI 0.02,1.1）respectively.Sensitivity of IMA for ischemic origin of cardiac ischemia was 86.67% as compared with 66.67% of ECG and 16.67% of cTnT.Conclusion：Plasma IMA assessment is valuable for early diagnosis of cardiac ischemia,and can improve the early diagnostic sensitivity of ACS significantly.

关 键 词：急性冠脉综合征(ACS) 缺血修饰白蛋白(IMA) 心肌缺血 白蛋白钴结合试验(ACB) 

分 类 号：R541.4[医药卫生—心血管疾病]