缺血修饰白蛋白与急性早期心肌梗死患者的相关性研究  

Correlationship research of ischemia modified albumin in patients with early acute myocardial infarction

作　　者：王奇军[1] 陈佩 曾琴飞 陈萍萍 应露漫 曹建明[1] 岑东[3] 

机构地区：[1]温州医科大学检验医学院,浙江温州325000 [2]宁波市鄞州人民医院检验科,浙江宁波315040 [3]宁波市鄞州区疾病预防控制中心,浙江宁波315100

出　　处：《检验医学》2014年第8期817-821,共5页Laboratory Medicine

摘　　要：目的探讨缺血修饰白蛋白（IMA）在早期急性心肌梗死（AMI）诊断中的临床价值。方法检测126例疑似AMI的胸痛患者[其中67例最终确诊为AMI（AMI组）,59例为非AMI（NAMI组）]在发病6 h内、6 h后（7-24 h）血清IMA、心肌肌钙蛋白I（cTnI）、肌红蛋白（MYO）和肌酸激酶同工酶（CK-MB）浓度,以50名无心肌疾患的健康者作为正常对照组,绘制受试者工作特征（ROC）曲线,观察IMA对AMI的诊断灵敏度及诊断效能。结果 AMI组血清IMA、cTnI、MYO和CK-MB浓度均明显高于NAMI组及正常对照组（P〈0.001）,NAMI组4项指标浓度亦高于正常对照组（P〈0.001）。ROC曲线显示IMA诊断早期AMI（〈6 h）的曲线下面积（AUC）为0.851[95%可信区间（CI）：0.775-0.926],最佳临界点为82.1 U/mL,灵敏度、特异性、阳性预测值和阴性预测值分别为82.2%、84.9%、85.9%和80.6%,灵敏度高于cTnI（50.7%,P〈0.001）、MYO（67.1%,P〈0.05）和CK-MB（20.9%,P〈0.001）。早期联合检测血清IMA、cTnI、MYO和CK-MB的阳性检出率可达92.5%。结论检测疑似AMI患者的IMA水平有助于AMI的早期临床诊断。多项心肌标志物联合检测可提高AMI的早期检出率。Objective To investigate the clinical significance of ischemia modified albumin（ IMA） in the early diagnosis of acute myocardial infarction（ AMI）. Methods A total of 126 patients with acute chest pain were enrolled.Through the final diagnosis,67 cases were AMI（ AMI group）,while the other 59 cases were non-AMI（ NAMI group）.Their serum concentrations of IMA,cardiac troponin I（ cTnI）,myoglobin（ MYO） and creatine kinase-MB（ CK-MB）were determined respectively within or more than 6 h（ 7-24 h） after the onset of chest pain. A total of 50 healthy subjects without cardiac disorders were enrolled as control group. The sensitivity and diagnostic effectiveness of IMA in the early diagnosis of AMI were evaluated by receiver operating characteristic（ ROC） curve. Results In AMI group,the serum levels of IMA,cTnI,MYO and CK-MB were higher than those in NAMI and control groups（ P〈 0. 001）,and the serum levels in NAMI group were also higher than those in control group（ P〈 0. 001）. The area under ROC curve（ AUC） of IMA（ 6 h） was 0. 851[95% confidence interval（ CI） ： 0. 775-0. 926]. At the optimal cut-off of82. 1 U /mL,the sensitivity,specificity,positive predictive value and negative predictive value were 82. 2%,84. 9%,85. 9% and 80. 6%,respectively. The sensitivity of IMA was higher than that of cTnI（ 50. 7%,P〈0. 001）,MYO（ 67.1%,P〈0.05） and CK-MB（ 20.9%,P〈0.001）. The positive detection rate for the combined determination of IMA,cTnI,MYO and CK-MB was 92. 5% in the early diagnosis of AMI. Conclusions The determination of IMA among the suspected AMI patients has important significance in the early diagnosis of AMI. The combined determination of cardiac markers can improve the positive detection rate of AMI.

关 键 词：缺血修饰白蛋白 肌红蛋白 心肌肌钙蛋白I 肌酸激酶同工酶 急性心肌梗死 

分 类 号：R446.1[医药卫生—诊断学]