【摘要】 目的评价缺血修饰清蛋白(IMA)检测对冠脉综合征(ACS)早期诊断的应用价值。方法连续监测急性胸痛患者发病后2、6、12、24 h的血清IMA、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)水平,并与健康人群对照,观察其变化规律。用ACB法测定IMA含量,免疫比浊法测定cTnI含量,免疫抑制酶动力学法测定CK-MB活性。结果IMA在稳定型心绞痛患者组无明显升高(P>0.05);在不稳定型心绞痛组可升高,发病后2~12 h内IMA水平与健康对照组比较有明显升高(P<0.05)。急性心肌梗死组IMA、CK-MB、cTnI均有不同程度的升高,心肌梗死发生后2 h其阳性率分别为85%、71%和55%,3项指标联合检测阳性率为92%;急性心肌梗死发生后6 h时,其阳性率分别为96%、87%和81%;当3项指标联合检测时,阳性率上升到99%。敏感性和特异性的受试者工作特征(ROC)曲线显示,急性心肌梗死发生后2 h和6 h时,IMA、CK-MB、cTnI的AUC值则分别为0.821、0.692、0.632和0.984、0.861、0.816。结论I MA在急性心肌梗死发生以前即不稳定型心绞痛时即可升高,IMA、CK-MB、cTnI 3项指标联合检测诊断急性心肌梗死,其敏感性明显优于单项检测,对急性心肌梗死的早期诊断具有较好的临床应用价值。更多还原

【Abstract】 Objective To evaluate the applicable value of ischemic modified albumin(IMA) in early diagnosis of acute coronary syndrome.Methods The serum levels of IMA,MB isoenzyme of creatine kinase(CK-MB) and cardiac troponin I(cTnI) were continuously monitored at 2,6,12 h and 24 h after onset in the patients of acute chest pain.Their variation regularity was investigated.The content of IMA was determined with albumin cobalt binding(ACB) test.Immunoturbidimetry was applied to measuring the content of cTnI,and immunological inhibition enzyme kinetics method applied to determining CK-MB activity.Results IMA was not significantly elevated in stable angina pectoris(SAP) group(P>0.05),but much elevated in unstable angina pectoris(UAP) group within 2-12 h after onset compared with that in healthy control group(P<0.05).IMA,CK-MB and cTnI were all increased in different degree in acute myocardial infarction group,and the positive rates were respectively 85%,71% and 55% at 2 h after acute myocardial infarction onset;and the positive rate of combined detection of above three indices accounted for 92%.The positive rates were respectively 96%,87% and 81% at 6 h after acute myocardial infarction onset;and the positive rate of combined detection of above three indices accounted for 99%.The ROC curve of sensitivity and specificity showed that the AUC value of IMA,CK-MB and cTnI were respectively 0.821,0.692,and 0.632 at 2 h after acute myocardial infarction onset,and 0.984,0.861 and 0.816 at 6 h.Conclusion The serum level of IMA increases when unstable angina pectoris occurs.The sensitivity of combined detection of IMA,CK-MB and cTnI is superior to that of single detection in diagnosis of acute myocardial infarction.Combined detection is of clinical value in the early diagnosis of acute myocardial infarction.更多还原