缺血修饰白蛋白和C反应蛋白在急性冠脉综合征诊断中的作用

嗜酸粒细胞性胃肠炎 误诊 嗜酸粒细胞增高 嗜酸粒细胞增多 临床表现 腹部不适 病例分析 误漏诊 目的：探讨缺血修饰白蛋白（IMA）及C反应蛋白（CRP）检测对急性冠咏综合征（ACS）的早期诊断评价。方法：监测急诊稳定型心绞痛（SA）和ACS患者共113例，入院后即刻取血测定IMA及CRP，观察其变化同时选择76例门诊体检者作对照．经受试者工作特征曲线（ROC曲线）分析获得区分SA与ACS最适界值点（cutoff值）.结果：ACS组与对照组、SA组间IMA、CRP值差异均具有统计学意义。IMA ROC曲线下面积为0．948，在最适cutoff值为70．5U／ml．时敏感性和特异性分别为94.4％和82．6％．阳性预测值和阴性预测值分别95．5％和79.2％，CRPROC曲线下面积为0．746，在最适cutoff值为4．905mg／L时敏感性和特异性分别为55．6％和87．0％，阳性预测值和阴性预测值分别78．1％和18.4％.结论：IMA可对急性心肌缺血作出早期诊断．且明显提高对ACS早期诊断敏感性

Ischemia-modified albumin and C reactive protein in diagnosis of acute coronary syndromes

Objective To investigate the values of ischemia-modified albumin(IMA) and C reactive protein (CRP) in early diagnosis of acute coronary syndromes(ACS). Methods Levels of IMA and CRP were detected in 113 patients with ACS or stable angina pectoris (SA) right after admission as were in 76 healthy controls. Receiver operator characteristic curve (ROC curve) analysis was used to determine the optimal cutoff of identifying ACS from SA. Results There were statistical differences in IMA and CRP levels between the patients with ACS and those with SA or the controls. The area beneath the ROC curve of IMA was 0.948. Sensitivity and specificity of IMA at a cutoff value of 70.5 U/mL were 94.4% and 82.6%. Positive predictive value of IMA for ischemia origin was 95.5% and negative was 79.2%. The area beneath the curves of CRP was 0.746. Sensitivity and specificity of CRP at a cutoff value of 4.905 mg/L were 55.6% and 87.0%. Positive predictive value of CRP for ACS was 78.1% and negative was 18.4%. Conclusions Early diagnosis of acute myocardial ischemia can be made by detection of IMA. IMA can significantly enhance the diagnostic sensitivity of ACS.