缺血修饰白蛋白在急性冠脉综合征的早期诊断中的临床应用

目的探讨缺血修饰白蛋白（ischemia modified albumin，IMA）对急性冠脉综合征（acute conoary syndrome，ACS）的早期诊断价值。方法128例疑似ACS患者在胸痛发作5h内取血测定IMA、肌钙蛋白I（cTnI）并在人院后即刻描记12导联心电图（ECG），同时选择75例健康对照进行检测，经ROC曲线分析获得区分非心肌缺血性胸痛（NICP）与ACS最适界值点（cutoff值）。IMA、cTnI及ECG结果分别与最终诊断结果（NICP，ACS）进行综合分析，评价其诊断ACS敏感性。结果ACS患者与NICP组问比较IMA值存在显著性差异，ROC曲线下面积0．957，在cutoff值为64．5U／ml时敏感性和特异性分别为92．3％和83．3％，诊断的阳性预测值和阴性预测值分别为93．4％和81．1％。入院即刻检查，IMA、cTnI、ECG诊断ACS的敏感性分别为92．4％、15．2％、43．5％。结论IMA对急性心肌缺血的早期诊断具有重要的临床意义，可明显提高ACS早期诊断的敏感性。

Clinical Application of Ischemia Modified Albumin in Early Diagnosis of Acute Coronary Syndromes

Objective To research the early diagnostic value of ischemia modified albumin （IMA） for acute coronary syndrome. Methods One hundred and twenty eight patients with suspected ACS within ,5 hours of acute chest pain were included. On admission, a 12 - lead electrocardiogram （ECG） was recorded and blood samples were taken for IMA and cardiac troponin I （cTnI） measurement. Seventy-five healthy subjects were served as normal controls. Patients underwent standardized triage, diagnostic procedures and treatment. Results of IMA showed with absorbance units （AbsU）. Receiver operating characteristic curve （ROC） analysis was used to determine the optimal cutoff of this assay for identifying individuals with ACS from non - ischemic individuals. Results of IMA, ECG and cTnl were correlated with the final diagnosis and their diagnostic sensitivities for ACS were evaluated. Results The results suggested that acute phase IMA values between those with ACS and NICP showed significant difference; and sensitivity and specificity at a cutoff value 64.,5 U/ml of IMA for diagnosis of ACS were 92.3 % and 83.3 %. Positive predictive value and negative predictive value of IMA for ischemia origin were 93.4 % and 81.1% respectively. Sensitivity of IMA for ischemic origin of chest pain was 92.4% as compared with 43.5% of ECG and 15.2 % of cTnl. Conclusions Plasma IMA assessment is valuable for early diagnosis of acute coronary ischemia, and will improve the early diagnostic sensitivity of ACS significantly.