血清缺血修饰白蛋白测定在心肌缺血早期的临床应用价值

目的探讨血清缺血修饰白蛋白（IMA）测定在心肌缺血早期的临床应用价值。方法检测46例急症胸痛最终确诊为急性冠状动脉综合征（ACS）的患者及50名健康体检者的血清IMA水平和临床常用的心肌损伤标志物肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白T（cTnT）]。通过绘制IMA在该人群中用于诊断ACS的受试者工作特征（ROC）曲线判定最佳临界值，确定IMA诊断ACS的敏感性、特异性、阳性预测值和阴性预测值。结果与正常对照组比较，ACS组IMA水平显著升高，为（81．88±21．89）U／mL（P〈0．01）。根据ROC曲线，当以Cut—off值为64．5U／mL时，此时IMA检测的敏感性、特异性、阳性预测值和阴性预测值较高，分别为82．61％、88．00％、86．36％和84．62％。46例ACS患者中，入院即刻IMA测定值超过最佳Cut—off值者为38例，阳性率达82．61％；而同步测定cTnT阳性者仅为9例，阳性率为19．57％；CK—MB阳性者仅为6例，阳性率为13．04％。IMA阳性率与其他两者比较差异有统计学意义（P〈0．05）。结论IMA是ACS的早期敏感指标，是评价早期出现的可逆性心肌缺血的生化标志物。

The clinical application of serum ischemia-modified albumin determination in the early diagnosis of myocardial ischemia

Objective To investigate the clinical application of serum ischemia-medified albumin (IMA) determination in the early diagnosis of myocardial ischemia. Methods The levels of serum IMA and classical cardiac markers creatine kinase MB(CK-MB) and cardiac troponin T(cTnT)]in 46 patients with acute coronary syndrome (ACS) and 50 healthy controls were determined. The optimal cut-off value of IMA was ascertained by receiver operating characteristic(ROC) curve. The sensitivity, specificity, positive and negative predictive values of IMA in the diagnosis of ACS were ascertained. Results The level of IMA in patients with ACS (81.88 ± 21.89) U/mL]was significantly higher than that in healthy controls (P < 0.01). According to the ROC curve, when the cut-off value of IMA was 64.5 U/mL,the sensitivity, specificity and both positive and negative predictive values of IMA were 82.61% ,88.00%, 86.36% and 84.62% respectively. In 46 patients with ACS,the IMA level of 38 patients at the time of admission had been already above the optimal cut-off value. The positive rate was 82.61%. Meanwhile, the value in only 9 patients was positive with cTnT and the value in 6 patients was positive with CK-MB. The positive rates were 19.57% and 13.04% respectively. There was significant difference between IMA and cTnT, CK-MB(P <0.05). Conclusions IMA is an early sensitive marker for ACS and an early biochemical marker for evaluating reversible myocardial ischemia.