IMA、Hcy和hs-CRP在ACS患者的诊断价值

目的：探讨急性冠脉综合征（acute coronary syndrome,ACS）患者缺血修饰性白蛋白（ischemia modified albumin,IMA）、同型半胱氨酸（homocysteine,Hcy）和高敏C反应蛋白（high-sensitivity C-reactive protein,hs-CRP）在ACS患者的诊断价值。方法：随机选择73例在胸痛3h内就诊的ACS患者,即时抽血检测IMA、Hcy和hs-CRP,与40例体检健康者进行对照比较,计算单项或联检的敏感性和特异性,绘制ROC曲线,计算ROC曲线下面积。结果：单指标检测,IMA对ACS的敏感性为87.67%,特异性为100%,高于Hcy和hs-CRP。IMA的ROC曲线下面积最大（面积：0.985;95%可信区间0.969~1.001）,临床诊断效能高于Hcy和hs-CRP。多指标联检,三指标联检敏感性可提高至97.26%,且敏感性和特异性之和最大。结论：IMA为一高度敏感的ACS诊断血清学标志物,其与Hcy和hs-CRP联检,有助于ACS的风险评估及早期诊断。

Clinical Diagnostic Value of Determination of Serum Ischemia Modified Albumin, Homocysteine and High- Sensitivity C- reactive Protein Levels in Patients with Acute Coronary Syndrome

Objective To study the clinical diagnostic value of determination of serum ischemia modified albumin （IMA）, ho- mocysteine （Hey） and high-sensitivity C -reactive protein （hs-CRP） levels in patients with acute coronary syndrome （ACS）. Methods Serum IMA （with albumin -cobalt binding assay）, Hcy （with ELISA） and ks -CRP （with R/A） levels were determined in 73 patients with ACS within 3 hours after onset of chest pain and 40 controls. Results The sensitivity of IMA was 87.67%, the specificity was 100%. The area under curve of ROC was 0.985 （95% confidence interval 0.969 - 1. 001 ）. All the figures were higher than those of Hcy and hs - CRP. Combined determination of IMA, Hcy and ks - CILP, would increass the sensitivity to 97.26%. Conclusion IMA is one of the earliest sensitive indicators for clinical diagnosis of early myocardial ischemia in patients with ACS. Combined determination of IMA, Hcy and ks - CRP would be even more sensitive.