缺血修饰白蛋白在急性缺血性心脏病中的法医学应用  

Application of Ischemia Modified Albumin for Acute Ischemic Heart Disease in Forensic Science

作　　者：王鹏[1,2] 朱泽磊[2,3] 朱宁[1] 于浩 岳强[1] 王晓龙[2] 冯春梅 王昌亮[2] 张国华[2] WANG Peng;ZHU Ze-lei;ZHU Ning;YU Hao;YUE Qiang;WANG Xiao-long;FENG Chun-mei;WANG Chang-liang;ZHANG Guo-hua(Criminal Police Detachment, Tieling Public Security Bureau, Tieling 112000, China;School of Forensic Medicine, China Medical University, Shenyang 110001, China;Criminal Investigation Detachment, Shijingshan Branch of Beijing Public Security Bureau, Beijing 100043, China)

机构地区：[1]铁岭市公安局刑警支队,辽宁铁岭112000 [2]中国医科大学法医学院,辽宁沈阳110001 [3]北京市公安局石景山分局刑侦支队,北京100043

出　　处：《法医学杂志》2017年第5期493-496,共4页Journal of Forensic Medicine

基　　金：公安部应用创新计划资助项目(2009YYCXLNST021)

摘　　要：目的探讨心包液中缺血修饰白蛋白(ischemia modified albumin,IMA)水平在心脏性猝死诊断中的应用价值及法医学意义。方法应用白蛋白-钴离子结合法检测急性缺血性心脏病组(36例)、急性心肌梗死组(6例)、心肌病组(4例)、对照组(15例)死者的心包液中IMA水平,比较各组之间IMA水平的差异。通过ROC曲线获得最佳IMA水平的截断值以及区分急性缺血性心脏病和对照组的敏感度和特异度。结果急性缺血性心脏病组心包液中IMA水平高于对照组(P<0.05);而与急性心肌梗死组、心肌病组心包液中IMA水平比较,差异均无统计学意义(P>0.05)。应用ROC曲线分析得出识别急性心肌缺血的IMA的截断值为40.65 U/m L,其诊断急性心肌缺血的敏感度为60.0%,特异度为80.5%。结论心包液中IMA有望作为诊断急性心肌缺血的参考指标,为心脏性猝死的法医学诊断提供客观依据。Objective To explore the application value and forensic significance of ischemia modified albumin(IMA)in pericardial fluid to diagnose sudden cardiac death.Methods IMA level in pericardial fluid was detected in acute ischemic heart disease group(n=36),acute myocardial infarction group(n=6),cardiomyopathy group(n=4)and control group(n=15)by albumin cobalt binding method.The levels of IMA were compared among these groups.The best cut-off IMA value was estimated and the sensitivity and specificity of acute myocardial ischemia group was distinguished from control group by receiver operating characteristics(ROC)curve.Results The IMA level in acute ischemic heart disease group was significantly higher than that of control group(P<0.05).Compared with acute myocardial infarction group and cardiomyopathy group,the IMA level in acute ischemic heart disease group had no significant difference(P<0.05).The cut-off value for the identification of acute myocardial ischemia which obtained by ROC analysis was40.65U/mL.And the sensitivity and specificity for distinguishing acute ischemia cardiac disease was60.0%and80.5%,respectively.Conclusion The IMA value in pericardial fluid can be a reference marker for the diagnosis of acute myocardial ischemia,which also can provide objective basis for the forensic identification of sudden cardiac death.

关 键 词：法医病理学 猝死 心脏 心肌缺血 白蛋白类 

分 类 号：DF795.1[医药卫生—法医学]