缺血修饰白蛋白测定联合心电图改变在急性冠状动脉综合征早期诊断价值  

The Value of Ischemia Modified Albumin in Early Diagnosis of Acute Coronary Syndrome

作　　者：季乃军[1] 蓝翔[1] 童丽军[1] 陈东海[1] 罗伟俊[1] 梅益斌[1] 胡昌盛[1] 李付远[1] 

机构地区：[1]温州医科大学附属第六医院心脏中心,323000

出　　处：《心电与循环》2013年第4期266-268,272,共4页Journal of Electrocardiology and Circulation

基　　金：丽水市科委医学重点学科课题(2009-12)

摘　　要：【摘要】目的探讨缺血修饰白蛋白（IMA）在急性冠状动脉综合征（ACS）早期诊断中的价值。方法152例ACS患者（ACS组）包含不稳定型心绞痛患者（UA，n=66），ST段抬高急性心肌梗死患者（STEMI，n=51）及非ST段抬高心肌梗死患者（NSTEMI。n=35）。依据发病至采血标本的时段不同将ACS组分为〈2h组（n=63）、2～4h组（n=48）及〉4h组（n=41）。检测静脉血IMA、肌钙蛋白l（cTnl）、肌红蛋白（Myb）、肌酸激酶同功酶（CK—MB）水平，并记录18导联体表心电图．并与同期因胸痛或上腹痛就诊的40例患者进行对照分析。结果ACS组IMA水平显著高于对照组（扭10．378，P〈0．01），STEMI者均显著高于UA者（t=4103，P〈0．01）和NSTEMl者（t=3．342。P〈0．01）。〉4h组患者血清IMA水平均显著低于〈2h组（t=5．387。P〈0．01）和2～4h组（t=5．214，P〈001）。IMA＋心电图测定，〈2h、2～4h、〉4h亚组的阳性率均为100％，与心电图和IMA测定差异均无统计意义（x。=0204，P〉0．05；x。=O．000。P〉0．05）。IMA对ACS诊断的阳性率94．1％，阳性预测值为100％，阴性预测值为100％；IMA联合心电图对ACS诊断的阳性率96．1％，阳性预测值为100％。阴性预测值为100％。结论ACS早期血清IMA显著升高，STEMl者均显著高于UA和NSTEMl者。与心电图、传统的心肌损伤指标比较，具有更高的阳性率。Objective To investigate the value of ischemia modified albumin （IMA） in early diagnosis of acute coro- nary syndrome （ACS）. Methods 66 patients with unstable angina （UA）, 51 patients with ST-elevation myocardial in- farction （STEMI）and 35 patients with non-ST-elevation myocardial infarction （NSTEMI）were eligible for this study. Ac- cording to the time from heart attack to blood sampling, patients were divided into 2h group （n=63）, 2~4h group （n=48） and 4h group （n=41）. Serum IMA, cardiac troponin I（ cTnl ）, myoglobin （ Myb ）and creatine kinase isoenzyme （ CK-MB ） were measured and 18-lead surface ECGs were recorded in the three groups and compared to those in control group with 40 patients referred to hospital due to pectoralgia or epigastric pain. Results IMA level was significantly higher in ACS patients than control group （t=10.378, P〈0. 01 ）, and in STEMI than in UA （t=4.103,P〈0.01）and NSTEMI patients （t=3.342,P〈0.01）. IMA was significantly lower in 4h group than 2h group （t=5.387,P〈0.01） and 2-4h group（t=5.214, P〈0. 01 ）. The positive rate of IMA ＋ECG was 100% in 2h,2-4h ,4h groups, which was not significant difference from IMA or ECG alone （X2=0.204,P 〉0.05;X2=0.000,P 〉0.05 ）. In the diagnosis of ACS, the positive rate, positive predictive value and negative predictive value of IMA were 94.1%, 100% and 100%, respectively, and those of IMA ＋ ECG were 96.1%, 100% and 100%, respectively. Conclusion Serum IMA increases early in ACS, which is more significant in STEMI than UA and NSTEMI patients. The positive rate of IMA is higher than ECG and traditional cardiac biomarkers.

关 键 词：急性冠状动脉综合征 缺血修饰白蛋白 心电图 诊断价值 

分 类 号：R541.4[医药卫生—心血管疾病]