急性冠状动脉综合征血清缺血修饰白蛋白的动态变化

目的:探讨血清缺血修饰白蛋白(IMA)对急性冠状动脉综合征早期的诊断价值。方法:将56例急性冠状动脉综合征患者分为三组,不稳定性心绞痛组(n=25),ST抬高心肌梗死组(n=20),非ST抬高心肌梗死组(n=11),另选50例健康体检者为正常对照组。分别于胸痛发作2、4、6、12及24 h抽血检测56例急性冠状动脉综合征患者的血清缺血修饰白蛋白、肌钙蛋白Ⅰ(cTnI)、肌酸激酶MB同工酶(CK-MB),分析缺血修饰白蛋白对急性冠状动脉综合征的诊断价值。结果:在急性冠状动脉综合征患者中缺血修饰白蛋白水平于胸痛发作2小时已明显增高并达高峰,4小时仍持续增高,明显高于正常对照组(P<0．01),6小时降至正常。而CK-MB、cTnI水平在胸痛发作4小时开始增高,6小时明显增高,以后逐步递增并在24小时达高峰。不稳定型心绞痛、ST抬高的心肌梗死、非ST抬高的心肌梗死三组中,缺血修饰白蛋白水平升高以不稳定型心绞痛组最明显。结论:缺血修饰白蛋白是诊断急性冠状动脉综合征的早期敏感指标,是目前唯一的诊断心肌缺血的生化标志物。     

IMA、DNaseⅠ、H-FABP对急性冠状动脉综合征的早期诊断价值

目的 探讨血清缺血修饰白蛋白(IMA)、脱氧核糖核酸酶Ⅰ(DNase Ⅰ)及心型脂肪酸结合蛋白(H-FABP)在急性冠状动脉综合征(ACS)中的早期诊断价值.方法 选取240例ACS患者作为观察组,260例同期无缺血性疾病者为对照组,分别采用比色法、SRED/CAM法、双抗体夹心法测定两组血液IMA、DNase Ⅰ、H-FABP水平.计算其对ACS诊断的灵敏度、特异度、阳性预测值和阴性预测值,并与肌钙蛋白Ⅰ(cTnⅠ)比较诊断效能.结果 观察组IMA、DNase Ⅰ及H-FABP明显高于对照组(P均＜0.05),IMA、DNase Ⅰ及H-FABP诊断ACS的灵敏度均高于cTnⅠ(P均＜0.05),IMA、DNase Ⅰ、H-FABP及cTnⅠ四者联合对ACS早期诊断灵敏度可达94.5％.结论 IMA、DNase Ⅰ联合H-FABP可提高对ACS早期诊断灵敏度.     

低T3综合征与急性冠状动脉综合征患者冠状动脉病变程度的相关性

目的 探讨低T3综合征(LT3S)与急性冠状动脉综合征(ACS)患者冠状动脉病变程度的相关性。方法 回顾性分析2018年8月至2019年12月中国人民解放军东部战区总医院收治的204例ACS患者的临床资料,分析其甲状腺功能情况,排除甲亢、亚临床甲亢、甲减、亚临床甲减后,将其余189例患者分为甲状腺功能正常组(对照组,n=153)和低T3综合征组(n=36)。采用 SPSS 25.0 统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ²检验进行组间比较。采用Spearman相关分析游离三碘甲状腺原氨酸(FT3)与Gensini评分、支架个数及B型脑钠肽的相关性。采用非条件logistic回归分析FT3与ACS患者重度冠状动脉病变的相关性,并绘制受试者工作特征(ROC)曲线判断FT3对ACS患者冠状动脉病变程度的预测价值。结果 低T3综合征组Gensini评分、支架个数及主干病变≥50%比例明显高于甲状腺功能正常组(均P<0.05)。FT3与糖尿病病史是影响ACS患者发生重度冠状动脉狭窄的独立危险因素(P<0.01)。FT3预测冠状动脉发生重度狭窄的ROC曲线下面积为0.697,最佳截断值为4.195pmol/L,灵敏度为69.8%,特异度为70.0%。结论 低T3综合征与ACS患者冠状动脉病变程度密切相关,FT3可以作为预测ACS患者冠状动脉病变程度的独立指标。     

缺血修饰白蛋白在急性冠状动脉综合征诊断中的意义

<正>急性冠状动脉综合征(acute coronary syndromes,ACS)在临床上十分常见,是心源性猝死的重要原因之一,死亡风险在10%左右。急性心肌梗死(acute myocardial infarction,AMI)是缺血时间过长引起的心肌细胞死亡。目前,生化标志物检测组合仍是ACS风险预测的首选[1]。通常选用肌红蛋白、肌钙蛋白I(cTnI)以及肌酸激酶同工酶(CK-MB)作为诊断ACS的标志物[2],然而,这些标志物仅仅在心肌细胞坏死之后释放入血液中才能被检测为阳性,不可作为判断心肌     

心肌损伤标志物在急性冠状动脉综合征诊疗中的价值

心肌损伤的血清标志物是指一类由于缺血、感染、创伤等原因引起心肌细胞损伤、膜的通透性增加或细胞结构发生改变后,出现于血液可反映心肌受损情况的生化标志物。现就国内外有关心肌损伤标志物的研究概况综述如下。     

缺血修饰白蛋白在老年急性冠状动脉综合征中的应用价值

目的探讨缺血修饰白蛋白(IMA)在老年急性冠状动脉综合征(ACS)早期诊断中的应用价值。方法收集急诊老年患者共153例作为病例组,年龄>65岁,入选患者均有胸痛、呼吸困难、或恶心呕吐上腹不适等典型(或不典型)症状的疑似ACS,所有患者在就诊即刻、12 h抽血检测IMA、肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白T(cTnT),入院后常规查18导联心电图(ECG)、心脏彩色B超、胸部X线、腹部彩色B超和冠状动脉造影。随机选择同期在本院进行健康体检的健康者80例作为对照组,空腹抽血检测IMA水平。分别评价IMA、cTnI、ECG指标对老年ACS患者缺血早期诊断的敏感度和特异度以及三者联合应用对ACS患者缺血早期诊断的敏感度和特异度。评估IMA对老年急性冠状动脉综合征的危险分层的应用价值。结果 153例病例中,12 h cTnT阳性86例,最终诊断ACS 95例,95例包括急性ST抬高心肌梗死(STEMI)36例、急性非ST抬高急性心肌梗死(NSTEMI)48例、不稳定型心绞痛(UA)11例、非ACS 58例;来诊即刻IMA对12 h cTnT阳性及最终诊断ACS的敏感度[95.3%(82/86)、96.8%(92/95)]、阴性预测值[92.7%(51/55)、94.5%(52/55)]最高,cTnT即刻的敏感度[26.7%(23/86)、25.3%(24/95)]、阴性预测值[50.8%(65/128)、44.5%(57/128)]很低,ECG对12 h cTnT阳性及最终诊断ACS的敏感度[40.7%(35/86)、41.1%(56/67)]、阴性预测值[52.3%(56/107)、47.7%(51/107)],3个指标联合应用对12 h cTnT阳性及最终诊断ACS的敏感度[98.8%(85/86)、97.9%(93/95)]、阴性预测值[98.1%(50/51)、96.1%(49/51)],在4组中ACS组IMA明显高于非ACS组且有统计学意义,AMI组高于UA组且有统计学意义(均为P<0.05)。结论 IMA在急症患者中对ACS的早期诊断和鉴别诊断应用价值很高,对危险分层有应用价值。     

心肌肌钙蛋白T与急性冠状动脉综合征

急性冠状动脉综合征代表冠状动脉病变程度不同的一组疾病 ,其临床表现为不稳定性心绞痛 ,急性心肌梗死和猝死。其共同的病理生理基础为急性粥样斑块破裂、血小板激活、血栓形成导致血管腔不同程度的阻塞[1] 。其结局和治疗措施不同 ,但是其临床诊断和预后分级常很困难。心肌肌钙蛋白 T( cardiac troponin T,c Tn T)是心肌细胞肌钙蛋白复合物的亚单位。心肌细胞受损时 ,c Tn T释放入血液 ,其浓度与心肌损伤程度紧密联系 [2 ]。 c Tn T与心肌细胞损伤的传统生化指标CK- MB相比 ,c Tn T有以下几个优点 :c Tn T的氨基酸序列不同于骨骼肌…     

联合检测IMA、cTnI、CK-MB早期诊断急性冠脉综合征的应用价值

目的观察血清缺血修饰白蛋白(IMA)、肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)在早期诊断急性冠脉综合征(ACS)中的应用价值。方法将60例ACS病人中不稳定型心绞痛29例作为观察1组,心肌梗死31例作为观察2组,所有病人于入院后检测即刻、6h、24h血清IMA、cTnI、CK-MB水平;对照组为20名同期健康体检者。比较3组IMA、cTnI、CK-MB水平差异;比较观察1组和观察2组即刻、6h、24h血清IMA、cTnI、CK-MB水平差异。结果观察1组和观察2组即刻cTnI、CK-MB水平与对照组比较,差异无统计学意义(P>0.05);观察2组6h、24hcTnI、CK-MB水平明显高于观察1组(P<0.05)。观察1组和观察2组即刻cTnI、CK-MB水平与对照组比较差异无统计学意义(P>0.05);观察2组6h、24hcTnI、CK-MB水平明显高于观察1组(P<0.05)。结论联合检测IMA、cTnI、CK-MB可提高ACS早期诊断效率及敏感性,具有重要意义。     

86例急性冠脉综合征患者血浆IMA检测及分析

测定86例急性冠脉综合征（ACS）患者（发病时间〈6h）和78例健康查体者血浆缺血修饰白蛋白（IMA）水平。结果IMA的95％界值为75U／ml，其诊断ACS的灵敏度为80％、特异度为48％。认为IMA是诊断心肌缺血的早期指标，与肌钙蛋白（cTnT）心电图（ECG）联合检测对于快速、正确诊断ACS具有重要价值。     

缺血修饰白蛋白在急性冠状动脉综合征危险分层中的诊断价值

目的:评估缺血修饰白蛋白(IMA)作为心肌缺血标志物在急性冠状动脉综合征(ACS)危险分层中的诊断价值。方法:入选2007年1月至2009年10月在我院救治的发病6h内可疑缺血性胸痛,且不符合急性ST段抬高心肌梗死(STEMI)诊断标准者。全数患者在入院即刻分别检测IMA、cTnT、CK-MB,并在发病12h后再次检测cT-nT。由2名心脏科专家在对IMA不知情的情况下,分别做出12h和临床最终诊断。根据12hcTnT结果和临床最终诊断,分别计算IMA诊断精确度。结果:313例可疑胸痛者中12hcTnT阳性、最终诊断ACS者分别为116和163例。对预测12hcTnT阳性,以急诊即刻cTnT特异性(99.49%)、阳性预测值(96.55%)、阳性似然比(47.31)最高,IMA测值最低;IMA敏感性(94.83%)、阴性预测值(95.59%)最高,阴性似然比(0.08)最低,IMA阴性组有6例患者12hcTnT阳性。对最终诊断ACS,IMA的特异性(90.79%)和敏感性(74%)均较低。163例最终诊断为ACS的患者中,非ST段抬高心肌梗死(NSTEMI)66例,STEMI30例,不稳定型心绞痛(UA)67例。3组IMA水平无显著差异,但较非ACS组IMA水平显著升高。结论:IMA存在少数假阴性,使临床安全性受限。由于IMA极低的检验特异性,且无法区别UA和急性心肌梗死,因此对ACS危险分层价值不高。     

Persistent epicardial adipose tissue accumulation is associated with coronary plaque vulnerability and future acute coronary syndrome in non-obese subjects with coronary artery disease

Objective. Epicardial adipose tissue (EAT) is recognized as a novel risk factor for coronary artery disease (CAD), and its contribution is thought to be stronger in non-obese patients than in obese patients. However, the prognostic impact of the progression of EAT accumulation after comprehensive management for atherosclerotic risk factors remains unclear. This study aimed to investigate whether an increase of the EAT volume during follow-up predicts future acute coronary syndrome (ACS) events in non-obese CAD patients. Methods. This study consisted of 517 non-obese CAD patients (368 men; age, 66 ± 10 years) who underwent serial multidetector computed tomography (MDCT) examinations to evaluate coronary atherosclerosis progression. The MDCT examination was used to assess the severity of stenosis, plaque characteristics, and EAT volume. All patients received comprehensive management to reduce CAD risk factors after the first MDCT examination. The MDCT examination was repeated at 6–24 months, and patients were followed-up for more than 1 year or until the occurrence of ACS events. Results. Of 517 patients, 159 (31%) patients were classified into increase of EAT volume during follow-up, 91 (18%) into decrease of EAT volume during follow-up, and 267 (51%) patients into constant of EAT volume during follow-up. The prevalence of obstructive plaques and MDCT-derived vulnerable features of coronary plaques were significantly elevated in patients with increase of EAT volume during follow-up. In contrast, no significant changes were observed in the other 2 groups. During the follow-up period of 4.1 ± 1.8 years (median 4.4 years) after the second MDCT examination, ACS occurred in 43 (8.3%) patients. Multivariate Cox regression analysis showed that the presence of low-attenuation plaque (hazard ratio [HR]; 1.78, p = 0.04) and napkin-ring sign (HR; 3.74, p < 0.001) at second MDCT examination, and changes of EAT volume per 10 ml (HR; 1.34, p = 0.004) were associated with future ACS events. Conclusion. Patients with increase of EAT volume during follow-up despite comprehensive management for CAD risks had an increased prevalence of obstructive plaques and plaques with high-risk features, which could be associated with unfavorable ACS outcomes in non-obese CAD patients.     

急性冠脉综合征患者血清正五聚蛋白和超敏C反应蛋白水平变化与预后的关联

目的探讨急性冠脉综合征(ACS)患者血清正五聚蛋白(PTX-3)和高敏C反应蛋白(hsCRP)水平变化及其与预后的关联。方法选自2012年4月至2013年4月吴忠市新区医院心内科临床诊断为冠状动脉粥样硬化性心脏病(冠心病)的患者132例,男性81例,女性51例,年龄范围40~75岁,分为稳定型心绞痛35例(SAP组),不稳定型心绞痛患者36例(UAP组),非ST段抬高型心肌梗死患者共32例(NSTEMI组),急性ST段抬高型心肌梗死患者29例(STEMI组)。另选同期年龄、性别相匹的正常体检者共35例(正常对照组)。检测PTX-3、hs-CRP水平,并随访1年主要心血管事件(MACE)的发生情况。结果与对照组比较,UAP组、NSTEMI组和STEMI组患者PTX-3、hs-CRP水平升高,差异具有统计学意义(P均0.05)。对97例ACS患者随访1年MACE的发生情况,33例发生MACE。通过ROC曲线计算血浆PTX-3、hs-CRP预测ACS患者发生MACE的最佳界值(cut off value)分别为PTX-3=6.05μg/L,hsCRP=8.21 mg/L,ROC曲线下面积为0.78、0.58。结论 PTX-3水平能够预测ACS患者MACE发生情况。     

Role of “Ischemia Modified Albumin” (IMA) in acute coronary syndromes

Background

Diagnosis of acute coronary syndrome (ACS) is important, due to the associated very high mortality. Failure to diagnose ACS is a problem both for the patients and the clinicians. Ischemia modified albumin (IMA) has already been licensed by the US Food and Drug Administration for the diagnosis of suspected myocardial ischemia.

Methods

Patients attending the emergency department (ED) within 6 h after having features of ACS were selected. IMA was done on admission. Blinded to the IMA results patients were fully evaluated and a diagnosis of non-ischemic chest pain (NICP), unstable angina (UA) or myocardial infarction (MI) was made. Later IMA results were correlated in each group.

Results

Mean IMA value was 56.38 ± 23.89 u/ml in NICP group whereas in UA group it was 89.00 ± 7.76 u/ml and MI group was 87.50 ± 9.62 u/ml. This showed a sensitivity of 92% and specificity of 87%. The positive predictive value of the test was 88% and negative predictive value was 94%. In 16 patients an early diagnosis could be made when compared with Trop-T. Of the 89 patients 11 patients died in hospital. The IMA value was compared between this group and the patients who survived. Patients who died had a mean IMA value of 88.5 with a standard deviation of 5.33 whereas in patients who survived the mean value was 78.26 which was not statistically significant.

Conclusion

In conclusion the benefit of the test would be to rule out ACS in patients who present early to ED with inconclusive diagnosis.     

Relation between the GRACE score and severity of atherosclerosis in acute coronary syndrome

BackgroundPatients with non-ST-elevation acute coronary syndrome are heterogeneous in terms of clinical presentation and immediate- and long-term risk of death or non-fatal ischemic events. The aim of the present study was to evaluate the relationship between the Global Registry of Acute Coronary Events (GRACE) score and severity of coronary artery disease angiographically evaluated by Gensini score in patients with non-ST-elevation acute coronary syndrome.MethodsA total of 245 patients with non-ST-elevation acute coronary syndrome were enrolled to the study. Based on the GRACE risk score classification system, the patients were divided into low- (n = 97, 39.6%), intermediate- (n = 84, 34.3%), and high- (n = 64, 26.1%) risk groups. All patients underwent coronary angiography within five days after admission.ResultsThe Gensini scores were 26 ± 29 in the low-risk group, 29 ± 19 in the intermediate-risk group, and 38 ± 23 in the high-risk group (p = 0.016). The low-risk group was significantly different from the high-risk group (p = 0.013), and the difference from the intermediate-risk group almost reached significance. Normal, noncritical, one and two, or multivessel disease were identified in 15 (6.1%), 31 (12.7%), 75 (30.6%), and 124 (50.6%) patients, respectively. The prevalence of multivessel disease was 28% in the low-risk group, 30% in the intermediate-risk group, and 42% in the high-risk group. The high-risk group was significantly different from the low-risk group (p < 0.01).ConclusionOur study demonstrates that the GRACE score has significant value for assessing the severity and extent of coronary artery stenosis in patients with non-ST-elevation acute coronary syndrome.     

Patients with acute coronary syndrome and normal high-sensitivity troponin

Background

Failure to identify patients with acute coronary syndrome (ACS) is a serious clinical problem. The incidence, characteristics, and outcome of ACS patients with normal high-sensitivity cardiac troponin T (hs-cTnT) levels at presentation are unknown.

Methods

In a prospective multicenter study, hs-cTnT was determined in a blinded fashion in 1181 consecutive patients presenting with acute chest pain to the emergency department. The final diagnosis of ACS was adjudicated by 2 independent cardiologists. Patients were followed for 12 months.

Results

ACS was the adjudicated diagnosis in 351 patients (30%), including 187 patients with acute myocardial infarction (AMI) and 164 patients with unstable angina (UA). At presentation, hs-cTnT was normal (<.014 ug/L) in 112 ACS patients (32%), including 11 patients (6%) with AMI and 101 patients (62%) with UA (P <.001). Multivariable analysis revealed previous statin treatment, younger age, preserved renal function, and the absence of ST deviation on the electrocardiogram as independently associated with normal hs-cTnT levels. Mortality rates in ACS patients with normal hs-cTnT level were 0.0% at 30 days, 0.0% at 90 days, and 2.0% (95% confidence interval, 0.5-7.9) at 360 days, which was significantly lower than in ACS patients with elevated hs-cTnT level at presentation (17.5% at 360 days, P <.001). Conversely, AMI rates at 360 days was higher in ACS patients with normal versus elevated hs-cTnT levels (P = .004).

Conclusion

Almost one third of ACS patients have normal hs-cTnT levels at presentation, mostly patients with UA. ACS patients with normal hs-cTnT have a very low mortality, but an increased rate of AMI during the subsequent 360 days.     

急性冠状动脉综合征患者血清BNP水平与hs-CRP、cTNI水平的相关性研究

目的探讨急性冠状动脉综合征(ACS)患者血清脑利钠肽(BNP)与高敏C反-应蛋白(hs-CRP)、心肌肌钙蛋白I(cTNI)指标的相关性及其在ACS患者危险分层中可能的临床意义。方法ACS患者41例包括急性心肌梗死患者21例和不稳定型心绞痛患者20例;稳定型心绞痛患者29例和与之年龄、性别等相匹配的30例对照者进入本研究。酶联免疫吸附法测定血清BNP水平,免疫比浊法测定hs-CRP水平,化学发光法测定cTNI水平。结果急性心肌梗死组和不稳定型心绞痛组患者的血清BNP水平均明显高于稳定型心绞痛和对照组患者,差异均具有统计学意义(P<0.01和P<0.05);在ACS组中,BNP与cTNI和hs-CRP具有相关性(r分别为0.67和0.91,P<0.05)。结论①血清BNP水平在ACS患者中明显升高,可作为辅助诊断指标之一。②ACS患者血清BNP水平升高程度与同期测定的血清hs-CRP、cTNI水平呈显著正相关。     

急性冠脉综合征与缺血修饰白蛋白

缺血修饰白蛋白是心肌缺血发生后到发生细胞坏死之前的一个非常早期的指标,主要根据人血清白蛋白N末端与钴离子的结合力的改变而测定,心肌缺血一旦发生,就迅速升高,缺血停止后仍能持续数小时。可用于急性冠脉综合征的早期诊断、短期危险分层及判断预后等方面。     

高敏C-反应蛋白与白介素-6在急性冠状动脉综合征意义

目的 探讨急性冠状动脉综合征(acute coronary symptom,ACS)病人血清高敏C反应蛋白(high sensitivity-C reactive protein,hs-CRP)和白介素-6(interleukin-6,IL-6)浓度的变化及临床意义.方法 ACS组ACS病人60例,稳定型心绞痛(stable angina pectoris,SAP)组病人40例,对照组为40名健康人,检测血清IL-6、hs-CRP水平.结果 ACS组血清IL-6、hs-CRP水平明显高于SAP组和对照组(P＜0.01);ACS组中,急性心肌梗死病人又高于不稳定型心绞痛病人(P＜0.05);SAP组与对照组差异无统计学意义(P＜0.05);血清IL-6和hs-CRP水平呈正相关(r=0.5942,P＜0.01).结论 ACS病人血清IL-6和hs-CRP升高,其水平变化反映ACS的严重程度.     

急性冠状动脉综合征患者血浆NT-proBNP水平与冠状动脉病变严重程度的关系

目的:探讨非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者,血浆N-末端脑钠肽前体(NT-proBNP)与冠状动脉病变严重程度的关系,以及对冠状动脉3支血管病变的预测价值。方法:入选2009年6月至2010年9月,在我院心内科住院的NSTE-ACS患者231例。入院后测定血浆NT-proBNP浓度,行冠状动脉造影检查并计算冠状动脉病变Gensini积分。分析NSTE-ACS患者血浆NT-proBNP浓度与Gensini积分的关系,与冠状动脉病变部位、病变支数的关系,以及对冠状动脉3支血管病变的预测价值。结果:NSTE-ACS患者冠状动脉3支病变组,LgNT-proBNP分别高于双支病变组(P<0.001)及单支病变组(P<0.001),双支病变组LgNT-proBNP高于单支病变组(P=0.021)。NT-proBNP按照中位数分组后,P50以上组LgGensini明显高于P50以下组(P<0.001)。NSTE-ACS患者的LgNT-proBNP与LgGensini呈正相关关系(r=0.55,P<0.001)。NSTE-ACS患者冠状动脉病变累及前降支(LAD)组的LgNT-proBNP高于未累及LAD组(P<0.001)。Logistic回归分析发现,随着NT-proBNP四分位数层级的升高,冠状动脉3支病变相应的比值比(OR)值逐渐增大,与最低层级相比,最高层级和第3个层级的OR值分别为13.54(P<0.001),95%CI(5.33,34.40)和6.70(P<0.001),95%CI(2.70,16.58)。使用受试者工作曲线(ROC)分析NT-proBNP,预测NSTE-ACS患者冠状动脉3支病变的曲线下面积(AUC)为0.765,P<0.001,95%CI(0.701,0.828)。结论:NSTE-ACS患者NT-proBNP水平越高,冠状动脉病变越严重;LAD病变者的NT-proBNP明显升高,高于未累及LAD者;NT-proBNP可作为预测NSTE-ACS患者冠状动脉3支血管病变的一个有效指标。