【摘要】 目的:评估缺血修饰白蛋白(IMA)作为心肌缺血标志物在急性冠状动脉综合征(ACS)危险分层中的诊断价值。方法:入选2007年1月至2009年10月在我院救治的发病6h内可疑缺血性胸痛,且不符合急性ST段抬高心肌梗死(STEMI)诊断标准者。全数患者在入院即刻分别检测IMA、cTnT、CK-MB,并在发病12h后再次检测cT-nT。由2名心脏科专家在对IMA不知情的情况下,分别做出12h和临床最终诊断。根据12hcTnT结果和临床最终诊断,分别计算IMA诊断精确度。结果:313例可疑胸痛者中12hcTnT阳性、最终诊断ACS者分别为116和163例。对预测12hcTnT阳性,以急诊即刻cTnT特异性(99.49%)、阳性预测值(96.55%)、阳性似然比(47.31)最高,IMA测值最低;IMA敏感性(94.83%)、阴性预测值(95.59%)最高,阴性似然比(0.08)最低,IMA阴性组有6例患者12hcTnT阳性。对最终诊断ACS,IMA的特异性(90.79%)和敏感性(74%)均较低。163例最终诊断为ACS的患者中,非ST段抬高心肌梗死(NSTEMI)66例,STEMI30例,不稳定型心绞痛(UA)67例。3组IMA水平无显著差异,但较非ACS组IMA水平显著升高。结论:IMA存在少数假阴性,使临床安全性受限。由于IMA极低的检验特异性,且无法区别UA和急性心肌梗死,因此对ACS危险分层价值不高。更多还原

【Abstract】 Objective:To evaluate the diagnositic value of ischemia modified albumin(IMA)as a biomarker of cardiac ischemia in risk stratification for acute coronary syndrome(ACS).Methods:Consecutive patients presenting with suspicious ischemic chest pain and without evidence of ST segment elevation myocardial infarction(STEMI)were enrolled.Serum levels of IMA、cTnT、CK-MB at presentation and delayed cTnT taken at 12h after pain onset were measured.The final clinic diagnosis was made by 2 cardiologists who were blind to the results of IMA.The diagnostic accuracy for IMA was calculated based on 12h cTnT results and the final clinical diagnosis.Results:Amony 313 patients with suspected chest pains,116 were 12h cTnT positive ACS,and 163 were ACS in the final diagnosis,resulting in specificity(99.49%),positive predictive value(96.55%),positive likelihood ratio(47.31).For IMA test values,sensitivity(94.83%),negative predictive value(95.59%)were the highest,negative likelihood ratio(0.08)was low.In the IMA-negative group,6 patients were 12h cTnT positive.In patients with final diagnosis of ACS,IMA specificity(90.79%)and sensitivity(74%)were lower.Out of the 163 cases diagnosed as ACS,there were 66 cases with non-ST-segment elevation myocardial infarction(NSTEMI),30 cases STEMI,and 67 cases unstable angina(UA).No significant differences were found among the three IMA groups,but the IMA level in the non-ACS group was significantly higher.Conclusion:This study suggests that there is a small portion of false negative IMA,which limits its safe use as a clinical test indicator.In the meantime,the extremely low level of test specificity of IMA and inability to distinguish UA from acute myocardial infarction(AMI)denote a low value of the ACS risk stratification approach.更多还原