冠心病患者血清缺血修饰白蛋白及心肌损伤标志物的变化和意义

目的探讨各类冠心病（CHD）患者血清缺血修饰白蛋白（Ischemia Mollified Albumin，IMA）及心肌损伤标志物的变化和意义。方法对我院确诊168例冠心病患者进行IMA、肌钙蛋白I（cTNI）、肌酸激酶MB（CKMB）、肌红蛋白（MYO）、心电图（ECG）、冠脉造影（CAG）检测，并进行统计分析。结果（1）IMA：除稳定性心绞痛（sA）组外，不稳定心绞痛（uA）、急性心梗（AMI）、陈旧心梗（EMI）组均与健康对照组（73例）有显著性差异P〈0．01；cTNI、CKMB、MYO：AMI组与各组均有显著差异P〈0．01。（2）按冠脉病变支数分四组，血清IMA及心肌损伤指标浓度比较显示：各组间IMA无显著性差异P〉0．05。（3）IMA与冠脉病变支数cTNI、CKMB、MYO相关性比较：r=-0．036、-0．355、-0．333、-0．280。（4）病人患高血压（HBP）时间与IMA、cTNI、CKMB、MYO相关性比较：r=0．220、-0．083、-0．132、-0．122。（5）ECG、IMA、cTNI、CKMB、MYO对各组的敏感性比较显示：IMA〉ECG〉cTNI、CKMB、MYO，IMA在各组中敏感性均最高，在AMI组可达98．8％。特异性比较显示：cTNI、CKMB、MYO〉ECG〉IMA，AMI组cTNI特异性最高可达97．5％。结论IMA是一种较理想的早期诊断心肌缺血的指标，能够辅助医生早期明确诊断，具有非常重要的临床应用价值。

The Value of Ischemia Mollified Albumin and the Protein Markers of Myocardial Injury in Coronary Heart Disease

Objective To discuss the value of ischemia mollified albumin（IMA） and the protein markers of myocardial injury in coronary heart disease. Methods Serum IMA cTNI、CKMB,MYO levels and ECG, CAG were studied in 168 CHD patients. Results （ 1 ） Comparing all patients with normal serum , except for SA the concentrations of IMA in UA , AMI, EMI Were significantly different, P 〈 0.01 ; There was significant difference between the AMI and other groups in IMA, cTNI, CKMB, MYO, P 〈 0.01 （2）According to the lesions of coronary, the patients were divided into four groups. Comparing serum IMA with the protein markers of myocardial Injury, there were not significantly different in four groups, P 〉 0.05. （3） There were relations between IMA and cTNI, CKMB, MYO. The relative coefficients were： r = -0.355, -0.333, -0.280. （4） There were relations between the time of patients suffering from HBP and IMA. The relative coefficient was ： r = 0. 220. （5） The diagnostic sensitivity of IMA is higher than ECG, cTNI, CKMB, MYO. The specific comparison is cTNI, CKMB, MYO 〉 ECG 〉 IMA. In the AMI the sensitivity of IMA is up to 98.8% and the specificity of cTNI is up to 97.5 %. Conclusion These results suggest that IMA is a good marker in the early diagnosis of myocardial ischemia, and a very important application value for clinical diagnosis.