缺血修饰白蛋白在急性心肌梗死早期诊断中的价值

目的探讨缺血修饰白蛋白(IMA)在急性心肌梗死(AMI)早期诊断中的意义。方法选择发病6 h以内以急性胸痛就诊的患者83例,根据出院诊断分为AMI组32例,非AMI组51例,其中不稳定型心绞痛(UAP)者33例,非心源性胸痛18例,健康对照组40例。利用白蛋白-钴结合试验(albumin cobalt binding test,ACB)原理间接测定IMA含量。探讨IMA对急性心肌梗死的诊断效能,并与传统的心肌标志物MYO、CK-MB、cTnI进行比较。结果应用ROC曲线分析所得IMA诊断急性心肌梗死的最佳截断值为67.08 U/ml,发病6 h以内IMA的敏感度、特异度、阴性预测值及准确率分别为81.25%、47.06%、80%、60.24%。其敏感度和阴性预测值明显高于传统心肌标志物MYO、CK-MB和cTnI。结论缺血修饰白蛋白(IMA)对AMI的早期识别,较传统的心肌损伤标志物具有更好的诊断预测价值。

Value of Ischemia Modified Albumin in the Early Diagnosis of Acute Myocardial Infarction

Objective To investigate the value of ischemia modified albumin（IMA） in early diagnosis of acute myocardial infarction（AMI）.Methods Eighty six patients who visited CNPC Central Hosiptial for acute chest pain within 6 hours after onset during January and November 2010 were randomly selected.All patients were classified by discharge diagnoses,32 patients classified into AMI group and 51 patients into non-AMI group,among which 33 patients had unstable angina pectoris（UAP group） and 18 patients had non-cardiac chest pain（NCCP group）.Forty healthy adults were recruited as control group.The plasma level of IMA was indirectly measured by albumin cobalt binding test（ACB）.The effectiveness of IMA in diagnosing AMI patients was explored and was compared with that of the traditional cardiac markers such as MYO,CK-MB and cTnI.Results According to the ROC curve drawn by ACB values of AMI group and control group,the optimum cut-off point for IMA levels in the AMI diagnosis was found to be 67.08 U/ml.The sensitivity,specificity,negative predictive value and accuracy of IMA for AMI diagnosis within 6 hours after onset of chest pain were 81.25%,47.06%,80% and 60.24%,respectively.The sensitivity and negative predictive value was obviously higher than those of the traditional cardiac markers,MYO,CK-MB and cTnI.Conclusions IMA can contribute to early identification of AMI and it has better diagnosis and prediction value than the traditional cardiac injury markers.