【摘要】 目的探讨缺血性修饰蛋白(ischemia modified albumin,IMA)在诊断急性胸痛患者中的临床价值。方法选取68例急性心肌梗死(acute myocardial infarction,AMI)患者(AMI组)、60例不稳定型心绞痛(unstable angina pectoris,UAP)患者(UAP组)与50例非心源性胸痛(non-cardiac chest pain,NCCP)患者(NCCP组)为研究对象。检测所有患者入院时、入院8 h及入院24 h的血清IMA及肌钙蛋白I(cardiac troponin,c Tn I)浓度,比较各组患者IMA及c Tn I浓度差异,分析血清IMA与c Tn I之间的相关性。绘制IMA诊断心源性胸痛的受试者工作特征曲线(receiver operator characteristic curve,ROC)并寻找IMA诊断心源性胸痛的最佳截断点和敏感性、特异性。结果入院时与UAP组和NCCP组相比,AMI组血清IMA浓度明显升高,差异有统计学意义(均P<0.05);入院3 h及8 h,AMI组血清IMA浓度仍明显高于UAP组和NCCP组,差异有统计学意义(均P<0.05);入院24 h时,AMI组血清IMA浓度进一步降低,与UAP组和NCCP组比较,差异无统计学意义(P>0.05)。入院时与UAP组和NCCP组相比,AMI组c Tn I浓度明显升高,差异有统计学意义(均P<0.05);入院3 h与8 h与UAP组和NCCP组相比,AMI组c Tn I浓度升高更为明显,差异有统计学意义(均P<0.05);入院24 h与UAP组和NCCP组相比,AMI组c Tn I浓度进一步升高,差异有统计学意义(均P<0.05)。相关性分析表明,AMI组患者血清IMA与c Tn I浓度呈显著正相关(r=0.878,P<0.001)。IMA诊断心源性胸痛的曲线下面积(AUC)为0.789[95%置信区间(0.698~0.880),P=0.000];最佳截断点为864.73μmol/L,此时敏感性、特异性和约登指数分别为0.939、0.500和0.439。结论心源性胸痛患者血清IMA浓度明显升高,其对于诊断心源性胸痛有较好的临床价值,值得在临床中推广应用。更多还原

【Abstract】 Objectives To discuss the clinical value of ischemia modified albumin(IMA)in diagnosis of patients with acute chest pain.Methods A total of 68 patients with acute myocardic infarction(AMI,AMI group),60 patients with unstable angina pectoris(UAP,UAP group)and 50 patients with non-cardiac chest pain(NCCP,NCCP group)were selected as research objects.Serum concentrations of IMA and cardiac troponin I(c Tn I)of all the groups at admission,eigth hours and 24 hours after hospitalizing were tested and compared.Correlation between serum IMA and c Tn I was analyzed.We drew the receiver-operating characteristic(ROC)curve of IMA to find the best cut-off score,sensitivity and specificity of IMA to diagnose cardiac chest pain.Results Serum concentration of IMA in AMI group increased obviously compared with UAP group and NCCP group on admission(all P<0.05);which was still higher than those of the other two groups at 3 hours and 8 hours after admitting at hospital(all P<0.05);which was further reduced at 24 hours after admitting at hospital,and has no significant difference when compared with those in UAP group and NCCP group(all P>0.05).Serum concentration of c Tn I in AMI group obviously increased compared with those in UAP group and NCCP group on admission(all P<0.05);which was increased further more compared with those in UAP group and NCCP group at 3 hours and 8 hours after admitting at hospital(all P<0.05);which was increased furthercompared with those in UAP group and NCCP group at 24 hours after admitting at hospital(all P<0.05).Correlationanalysis showed that serum concentration of IMA and c Tn I in AMI group positively related(r=0.878,P<0.001).ROCcurve of IMA to diagnose cardiac chest pain was 0.789[95% confidence interval(0.698-0.880),P=0.000]and the bestcut-off score was 864.73 μmol/L(the sensitivity,specificity and Yoden index were respectively 0.939,0.500 and0.439).Conclusions Serum concentration of IMA in patients with cardiac chest pain increased obviously and it canhelp to diagnose cardiac chest pain.It is worth popularizing in clinical application.更多还原