【摘要】 目的:探讨生化标志物联合检测对急性冠脉综合征(ACS)的早期诊断价值。方法:对156例因胸痛4 h就诊患者,以冠状动脉造影(CAG)为诊断依据,分为ACS组(112例)和非缺血性胸痛(NICP)组(44例)。在胸痛<4 h和4~8 h分别抽血测定缺血修饰白蛋白(IMA),乳酸脱氢酶(LDH),肌酸激酶(CK),肌酸激酶同工酶(CK-MB)及心脏肌钙蛋白I(cTnI)等心脏生化标志物,并结合CAG检查结果进行综合分析。结果:在发病4h内对ACS诊断敏感性最高的是IMA(87.50%),特异性最高的是cTnI达95.45%,准确性最高的是IMA达80.77%;4~8h对ACS诊断敏感性最高的是IMA,达91.07%,特异性最高的是cTnI(97.73%),准确性最高的是CK和IMA,二者分别为85.90%,85.25%,无显著差异,并列第一。综合判断,无论是<4h,还是4~8h,敏感性和准确性最高的是IMA,特异性最高的是cTnI。4 h内IMA等5项指标联合检测可提高敏感性达89.28%,特异性达95.45%,准确性达91.02%,均为最高水平。结论:对于诊断急性冠脉综合征,IMA的敏感性和准确性最高,cTnI的特异性最高,IMA等5种指标联合检测可将其诊断提高到最高水平更多还原

【Abstract】 Objective:To explore early diagnostic value of combined detection of ischemia-modified albumin and other biochemical markers for acute coronary syndrome(ACS).Methods:A total of 156 patients,who received treatment within 4h because of chest pain onset,were divided into ACS group(n=112)and non-ischemic chest pain group(NICP group,n=44)according to coronary angiography(CAG).Blood sample was taken within4h and during 4~8h after chest pain to measure cardiac biochemical markers,including ischemia-modified albumin(IMA),LDH,CK,CK-MB and cardiac troponin I(cTnI),comprehensive analysis was performed by detected results of above biochemical markers and CAG.Results:For diagnosis of ACS,within 4h after onset IMA possessed highest sensitivity(87.50%)and highest accuracy(80.77%),cTnI possessed highest specificity(95.45%);In 4~8h IMA still possessed highest sensitivity(91.07%),cTnI still possessed highest specificity(97.73%),CK(85.90%),and IMA(85.25%)possessed highest accuracy(both CK and IMA had no significant difference);According to comprehensive analysis,regardless of within 4h or during 4~8h after chest pain,IMA possessed highest sensitivity and highest accuracy,cTnI possessed highest specificity.Within4h after chest pain,Detection of IMA combined abovementioned other four indexes increased sensitivity(89.28%),specificity(95.45%)and accuracy(91.02%)to highest level.Conclusion:For diagnosis of ACS,IMA possesses highest sensitivity and highest accuracy,cTnI possesses highest specificity;IMA combined above-mentioned other four indexes may increase sensitivity,specificity and accuracy to highest level.更多还原