IMA早期诊断结合介入治疗在UAP中的临床应用研究  

Clinical application of IMA early diagnosis combined with interventional therapy in the treatment of unstable angina

作　　者：宋代黎 邱亦萍 黄海峰 李筱敏 吴同果[2] 

机构地区：[1]广东省佛山市南海区第三人民医院,广东佛山528244 [2]广州市红十字会医院,广东广州510000

出　　处：《中国医药科学》2013年第15期9-12,共4页China Medicine And Pharmacy

基　　金：广东省佛山市医学类科技攻关项目(201108155)

摘　　要：目的通过观察不稳定型心绞痛(UAP)患者在经皮冠状动脉介入治疗术(PCI)前后血清中的缺血性修饰白蛋白(IMA)、心肌肌钙蛋白(cTnI)及肌酸激酶同功酶(CK-MB)的浓度变化,探讨IMA在UAP早期诊断与治疗中的作用,为临床UAP的早期诊断与治疗提供客观依据。方法 43例研究对象均选自诊断为UAP的住院且在住院期间再次出现胸痛发作患者,其中26例为行PCI治疗的冠心病患者(研究组),同时以17例仅行诊断性冠脉造影的患者为对照组,两组患者均于术前术后0.5、6、12 h采集血样测定IMA、cTnI及CK-MB的浓度,详细记录研究组患者术中的球囊扩张的压力、时间、次数,植入支架的部位和数目,术中、术后1 d的心电图变化。结果研究组有24例患者的IMA在术后0.5 h较术前明显升高(P<0.05),术后6 h开始下降,术后12 h逐渐恢复至基线水平;而cTnI在术前、术后0.5、6 h的变化不明显,有17例患者于术后12 h升高,与其他时间段相比较差异有显著性(P<0.05),但其CK-MB于术前及术后各时间点的变化不明显(P>0.05),未见升高患者。而对照组患者术前、术后各时间点的IMA、cTnI及CK-MB的变化均不明显(P>0.05)。结论 PCI术会导致心肌发生缺血缺氧损伤,且IMA在PCI术后迅速升高,且比cTnl和CK-MB的出现要早;IMA的升高与术中球囊扩张的总压力、持续时间、扩张次数呈正相关。即IMA可作为早期及PCI术后诊断UAP的一个心肌标志物。Objective By observing unstable angina pectoris （UAP） patients in the percutaneous coronaryintervention therapy （PCI） of serum ischemia-modified albumin （IMA）, cardiac troponin I （cTnI） and creatine kinaseisoenzyme （concentration of CK-MB）, and to explore the role of IMA in the UAP early diagnosis and treatment of,and provide an objective basis for the early diagnosis and treatment of clinical UAP. Methods 43 subjects wereselected from a diagnosis of UAP hospitalization and recurrence of chest pain patients during hospitalization, including26 cases of coronary heart disease patients treated with PCI （study group）, while 17 cases by diagnostic coronary angiographypatients of the control group, patients in both groups before surgery postoperative 0.5, 6,12 h collecting bloodsamples determination of IMA, cTnIand CK-MB concentration, a detailed record of the balloon dilatation pressurein the patients of the study group, time, number of, the location and number of stents, surgery, postoperative day EGGchanges. Results Study group of 24 patients IMA was significantly higher （P 〈 0.05） after 6 h after 0.5 h comparedwith the preoperative began to decline, 12 h after gradually returned to baseline levels; cTnIin the preoperative andpostoperative 0.5 h,6 h did not change significantly, 17 patients with elevated after 12 h, and other time periods andthe difference was significant （P 〈 0.05）,but changes in CK-MB in the preoperative and postoperative time points notobvious （P 〉 0.05）,no increase in patients. The control group patients before, after point in time the IMA, cTnIandCK-MB changes are not significant （P 〉 0.05）. Conclusion PCI, will lead to the damage of the myocardial ischemiaand hypoxia, and IMA increased rapidly after PCI, and earlier than cTnIand CK-MB appear; elevated IMA＇s andintraoperative balloon dilatation of the total pressure, duration, the number of expansion was positively correlated. IMAcan be used as a cardiac marker of early PCI after diagnosis of UA

关 键 词：不稳定型心绞痛 缺血性修饰白蛋白 肌钙蛋白 肌酸激酶同工酶-MB 

分 类 号：R541[医药卫生—心血管疾病]