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。

Value of ischemia modified albumin in elderly patients with acute coronary syndrome

Objective To investigate the diagnostic value of ischemia-modified albumin（ IMA） in elderly patients with acute coronary syndrome（ ACS）. Methods Data of 153 elderly patients suspected for ACS were collected as case group. Blood sample was obtained for the measurement of IMA,CK-MB and cTnT in all patients at emergency department and 12 hours（ 12 h） later. Routine check of the 18-lead electrocardiogram（ ECG）,echocardiography,chest X-ray,abdominal ultrasound,coronary angiography was performed in all cases. Eighty healthy people were selected as the control group. The sensitivity and specificity of IMA,cTnT,ECG and the combination of the three indicators for early diagnosis of ischemia in elderly patients with ACS were separately evaluated. The value of IMA in stratification of elderly patients with ACS was also evaluated. Results Of the 153 cases,95 were diagnosed ACS including 36 cases with acute ST elevation myocardial infarction（ STEMI）,48 with acute non-ST elevation acute myocardial infarction（ NSTEMI） and 11 with unstable angina（ UA） ],and 86 were found cTnT positive at 12 h. The sensitivity of IMA for cTnT positive at 12 h and the diagnosis of ACS were 95. 3%（ 82 /86） and 96. 8%（ 92/95）,respectively],and negative predictive value were 92.7%（ 51/55） and 94.5%（ 52/55）,respectively]. The sensitivities and negative predictive values of cTnT 26. 7%（ 23 /86）,25. 3%（ 24 /95）and 50. 8%（ 65 /128）,44. 5%（ 57 /128） ] and ECG 40. 7%（ 35 /86）,41. 1%（ 39 /95） and 52. 3%（ 56/107）,47.7%（ 51/107） ] at admission were poor. The sensitivity of combination of the three indicators were 98. 8%（ 85 /86） and 97. 9%（ 93 /95）,respectively] and negative predictive value were98.1%（ 50/51） and 96.1%（ 49/51）,respectively]. IMA in ACS group was significantly higher than in non-ACS group（ P〈0. 05）. Conclusions IMA can be used to the early diagnosis and risk stratification in elderly patients with ACS.