缺血修饰白蛋白对重型颅脑损伤患者早期心肌损伤的评估价值

目的探讨缺血修饰白蛋白（IMA）对重型颅脑损伤继发心肌损伤的早期诊断价值及其与患者预后的关系。方法检测52例重型颅脑损伤患者（实验组）血清IMA、心肌肌钙蛋白（cTnI）、肌酸激酶同工酶（CK～MB）、肌红蛋白（MYO），并检测同期46例健康体检者血清IMA。结果实验组血清IMA水平显著高于对照组（P〈0．01）。实验组血清IMA、cTnI、MYO、CK-MB阳性率分别为78．84％、53．85％、32．69％、30．77％，IMA的阳性率显著高于cTnI、MYO、CK—MB的阳性率（P〈0．01）。GCS6-8分组、4-5分组、3分组的ACB值分别为（67.21±5．96）U／ml、（52．85±5．13）U／ml、（40．78±4．85）U／ml，三组间ACB值有统计学差异（P〈0．05）。预后差（GOS评分4～5分）患者血清IMA水平显著低于预后好患者（GOS评分1～3分，P〈0．01）。结论IMA对重型颅脑损伤继发心肌损伤的早期诊断有重要价值，并且检测IMA有助于评估重型颅脑损伤患者的病情严重程度及预后。

Value of ischemia-modified albumin in early diagnosis of secondary myocardial injury in patients with severe traumatic brain injury

Objective To investigate the value of ischemia-modified albumin （IMA） in early diagnosis of secondary myocardial injury （SMI） in patients with severe traumatic brain injury （sTBI） and the relationship between the serum level of IMA and the prognosis of patients with sTBI. Methods Fifty-two consecutive patients with sTBI were collected as experimental group and 46 health adults were collected as control group in this study. The serum level of IMA was detected by albumin cobalt binding assay （ACB） and the ACB value was used to evaluate the serum level of IMA （A lower ACB value indicates a higher serum level of IMA）. The serum levels of cardiac troponin I （cTnI）, creatine kinase MB （CK-MB） and myoglobin （MYO） were detected by Olympus AU2700 automated biochemistry analyzer within 3 hours after trauma. The prognosis was assessed according to GOS score 6 months ＂after discharge. Good prognosis had GOS score of 4-5 points and poor prognosis had GOS score of 1-3 points. Results The ACB value of IMA in experimental group （57.68± 5.28 U/ml） was significantly lower than that （78.35±6.53 U/ml） in control group （P〈0.01）. The positive rate of serum IMA （78.84%） was significantly higher than cTnI （53.85%; P〈0.01）, MYO （32.69%; P〈0.01） and CK-MB （30.77%; P〈0.01）. The ACB values of patients with GCS score of 6-8, 4~5 and 3 points were 67.21±5.96 U/ml, 52.85±5.13 U/ml and 40.78±4.85 U/ml, respectively; there were significant difference among those patients （P〈0.01）. The ACB value of patients of poor prognosis （41.26±5.13 U/ml） was significantly lower than that （59.38±5.31 U/ml） of those of good prognosis （P〈0.01）. Conclusions The serum level of IMA is superior to cTnI, MYO and CK-MB in early diagnosis of SMI in patients with sTBI. The serum level of IMA can be used to evaluate the severity and prognosis in patients with sTBI.