缺血修饰性白蛋白分泌与心肌缺血相关指标的关系

目的探讨心肌缺血时缺血修饰性白蛋白（ischemia modified albumin，IMA）分泌及与相关指标的关系。方法随机选择73例在胸痛3h内就诊的急性冠脉综合征患者（acute coronary syndrome，ACS），分别在就诊时（3h组）和胸痛6h时（6h组）抽血检测IMA，同时检测心肌坏死指标：肌酸激酶同功酶（CK—MB）、肌钙蛋白I（cTnI）和肌红蛋白（Myo），与40例健康体检者（健康对照组）进行对照比较。结果ACS患者3h组血清IMA、Myo水平显著高于健康对照组（P〈0．01）；而CK—MB、cTnI与健康对照组比较无显著性差异（P〉0．05）；3h组与6h组比较，仅IMA水平无显著性差异；6h组与健康对照组比较所有指标均呈显著性升高。相关性分析显示血清1MA水平与CK—MB、cTnI、Myo呈正相关性（r=0．498，P〈0．01；r=0．514，P〈0．01；r=0．506，P〈0．01）。结论IMA是反映ACS心肌缺血的一个非常早的灵敏指标，对于发病〈3h的ACS更有价值，结合Myo有助于ACS的早期诊断和排除诊断，并可能与随后的心肌坏死存在关联。

Relations Between Isehemia Modified Albumin Excretion and Myocardial Ischemia-related Indicators

Objective To discuss the relations between ischemia modified albumin excretion and myocardial ischemia -related indicators. Methods 73 acute coronary syndrome patients who visited doctors 3 hours after chest pain occurred were selected at random. IMA and the indicators of myocardial necrosis （ CK - MB, cTnI and Myo） were detected by intravenous haemospasia at visiting （3-hour group） and 6-hour after chest pain occurred （6- hour group） to compare with the marks of 40 healthy people （ Control group）. Results IMA and Myo in 3-hour group were increased significantly compared with the control group （both P 〈 0. 01）, but there was no significant difference in CK -MB and cTnI between 3-hour group and control group （ P 〉0.05）, and there was no significant difference only in IMA between 3-hour group and 6-hour group. All the indicators were increased significantly in 6- hour group. The results of correlation analysis show that IMA had a positive correlation with CK - MB, cTnI and Myo （r =0.498, P 〈0.01; r =0. 514, P 〈0.01; r =0. 506, P 〈0. 01）. Conclusion IMA is one of the earliest sensitive indicators which help the clinical diagnosis of early myocardial ischemia in the incidence of acute coronary syndrome, it has more value in the diagnosis of ACS which occurs in 3 hours. There probably exists a correlation between IMA and the indicators of myocardial necrosis.