缺血修饰白蛋白联合运动平板试验对隐匿型冠心病的诊断价值

目的：本研究旨在通过运动平板试验诱发心肌缺血,评价缺血修饰白蛋白（IMA）联合运动平板（TET）对隐匿型冠心病（SMI）的诊断价值。方法：选择80名其中男55例,女25例;平均年龄（54±8）岁]疑似SMI患者,一周内先后行TET及冠状动脉造影（CAG）检查,TET前及TET后2h分别检测IMA,结合CAG结果将研究对象分为冠心病（CHD）组和非冠心病（NCHD）组,观察TET前后IMA浓度的变化并比较CHD组不同冠状动脉狭窄程度IMA的水平,分析IMA及其与TET联合诊断SMI的敏感性？特异性？阳性预测值？阴性预测值。结果：80名入选对象中,诊断为CHD33例,NCHD47例。NCHD组TET前后IMA水平无明显差异（P〉0.05）,CHD组TET前后IMA水平差异有统计学意义（P〈0.05）;NCHD和CHD组间比较,TET前IMA水平差异无统计学意义（P〉0.05）,TET后IMA水平CHD组显著高于NCHD组（13.3±3.5）vs（4.7±1.8）ng/mL,P〈0.01]。TET后IMA对SMI诊断的敏感性为81.8%,特异性为76.6%,阳性预测值为71.1%,阴性预测值为85.7%,TET后IMA联合TET对SMI诊断的敏感性为93.8%,特异性为87.5%。阳性预测值为83.3%,阴性预测值为95.5%。结论：IMA是心肌缺血的早期生化标志物,TET后2h测定IMA对诊断SMI有较高的敏感性和阴性预测值,与TET联合诊断SMI的价值更高。

Evaluation of co-detection of ischemia modified albumin and treadmill exercise test in the diagnosis of silent myocardial ischemia

AIM：To evaluate the diagnostic value of co-detection of ischemia modified albumin （IMA） and treadmill exercise test （TET） for silent myocardial ischemia （SMI）.METHODS：80 patients 55 males and 25 females;mean age （54±8） years] with suspected SMI were selected.All patients were examined with TET and coronary arteriongraphy（CAG） in one week.IMA was detected before TET and two hours after TET.All patients were divided into CHD and NCHD groups combined with the results of CAG.Changes in the concentration of IMA were observed of two groups before and after TET.The diagnostic value of co-detection of ischemia modified albumin and treadmill exercise test was evaluated for SMI.RESULTS：Among the 80 patients,it was diagnosed as CHD 33 cases,NCHD 47 cases.There were significant higher levels of IMA after TET in CHD group （P0.05）,but no significant differences in NCHD group （P0.05）.IMA levels were significantly higher in the patients of CHD after TET than those patients of NCHD（13.3±3.5） vs （4.7±1.8） ng/mL,P0.01].But before TET,there were no significant differences between CHD and NCHD groups （P0.05）.The sensitivity value was 81.8% for IMA after TET,specificity was 76.6%,positive predictive value was 71.1%,negative predictive value was 85.7%.The sensitivity was 93.8% with the co-detection of IMA and TET,specificity was 87.5%,positive predictive value was 83.3%,negative predictive value was 95.5%.CONCLUSION：IMA is a useful biochemical marker for the early myocardial ischemia.There is a high sensitivity and negative predictive value for IMA two hours after TET in the diagnosis of SMI.There is much higher diagnostic value with the co-detection of IMA and TET.