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目的:探讨血清缺血修饰白蛋白(IMA)水平检测在急性心肌缺血早期诊断中的应用价值。方法:采用白蛋白钴结合试验(ACB试验)间接测定50例急性冠状动脉综合征(ACS组)、50例慢性稳定型心绞痛(SAP组)和50例非缺血性心脏病(对照组)患者的血清IMA水平,比较ACS组患者胸痛发作后3h内血清ACB值,并与SAP组、对照组患者血清ACB值的差异;比较ACS患者中不稳定型心绞痛(UA)患者与急性心肌梗死(AMI)患者ACB值差异;应用受试者工作特征曲线分析获得识别急性心肌缺血的最佳ACB值截断值。结果:ACS患者胸痛发作后3h内血清ACB值为(79.62±9.20)U/ml,明显低于SAP组(90.88±7.05)U/ml和对照组(99.52±3.62)U/ml,P<0.01;UA患者胸痛发作后3h内ACB值为(88.90±8.63)U/ml,与AMI患者(79.48±11.06)U/ml比较差异无统计学意义(P>0.05)。应用ROC曲线分析得出早期识别急性心肌缺血的ACB值截断值为83U/ml,以此值诊断急性心肌缺血的敏感性为74%,特异性为86%。结论:IMA是急性心肌缺血早期诊断的敏感生物标记物,但不是鉴别急性心肌缺血与坏死的生物学指标。应用ACB值最佳截断值诊断急性心肌缺血,有较高的敏感性和特异性。
Objective: To investigate the value of detecting serum ischemia-modified albumin (IMA) in the early diagnosis of acute myocardial ischemia. Methods: 50 patients with acute coronary syndrome (ACS), 50 patients with chronic stable angina pectoris (SAP) and 50 patients with non-ischemic heart disease (control group) were measured indirectly by albumin-cobalt binding assay (ACB) Serum IMA levels in ACS patients were compared. The serum ACB values within 3 hours after the onset of chest pain in ACS patients were compared with those in SAP patients and control subjects. The differences of serum ACB values between ACS patients and UA patients were compared with those of acute myocardial infarction (AMI) ) Patients with ACB value differences; application of the receiver operating characteristic curve analysis to identify the best ACB value of acute myocardial ischemia cut-off value. Results: Serum ACB value was 79.62 ± 9.20 U / ml within 3 hours after onset of chest pain in ACS patients, which was significantly lower than that in SAP group (90.88 ± 7.05) U / ml and control group (99.52 ± 3.62) U / ml, P <0.01 (88.90 ± 8.63) U / ml within 3h after onset of chest pain in UA patients, but no significant difference with AMI patients (79.48 ± 11.06) U / ml (P> 0.05). According to ROC curve analysis, the cut-off value of ACB value for early diagnosis of acute myocardial ischemia was 83U / ml. The sensitivity and specificity of this method in diagnosing acute myocardial ischemia were 74% and 86% respectively. Conclusion: IMA is a sensitive biomarker for early diagnosis of acute myocardial ischemia, but it is not a biological indicator to identify acute myocardial ischemia and necrosis. Application of ACB value of the best cut-off value of the diagnosis of acute myocardial ischemia, high sensitivity and specificity.