中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2010年
9期
905-907
,共3页
许明正%奚志钢%俞国忠%何纪峰%刘全有%任积廷
許明正%奚誌鋼%俞國忠%何紀峰%劉全有%任積廷
허명정%해지강%유국충%하기봉%류전유%임적정
缺血修饰白蛋白%急性冠状动脉综合征%非心肌缺血性胸痛
缺血脩飾白蛋白%急性冠狀動脈綜閤徵%非心肌缺血性胸痛
결혈수식백단백%급성관상동맥종합정%비심기결혈성흉통
Ischemia modified albumin%Acute coronary syndrome%Non-ischemic chest pain
目的 探讨缺血修饰白蛋白(IMA)对急性冠状动脉综合征(ACS)的早期诊断价值.方法 103例疑似ACS患者[非心肌缺血性胸痛(NICP)45例(NICP组),ACS 58例(ACS组)]在胸痛发作5 h内取血测定IMA、肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)并在入院后即刻描记12导联心电图(ECG),同时选择30例健康对照(对照组)进行检测,经ROC曲线分析获得区分NICP与ACS最佳,临界值点(Cut-off值).IMA、cTnI、CK-MB及ECG结果分别与最终诊断结果(NICP,ACS)进行综合分析,评价其诊断ACS的敏感性.结果 ACS组与NICP组IMA值分别是(89.66±25.82)、(46.79±17.20)U/ml,2组间比较IMA值差异有统计学意义(P＜0.05);ROC曲线下面积0.935,最佳临界值为71.6 U/ml,此时IMA检测的敏感性、特异性、阳性预测值和阴性预测值分别为90.6%、71.4%、82.8%和83.3%.而同步测定cTnI、CK-MB、ECG诊断ACS的阳性率分别为29.3%、27.6%、48.3%.结论 IMA是诊断急性心肌缺血早期灵敏指标,可明显提高ACS早期诊断的敏感性.
目的 探討缺血脩飾白蛋白(IMA)對急性冠狀動脈綜閤徵(ACS)的早期診斷價值.方法 103例疑似ACS患者[非心肌缺血性胸痛(NICP)45例(NICP組),ACS 58例(ACS組)]在胸痛髮作5 h內取血測定IMA、肌鈣蛋白I(cTnI)、肌痠激酶同工酶MB(CK-MB)併在入院後即刻描記12導聯心電圖(ECG),同時選擇30例健康對照(對照組)進行檢測,經ROC麯線分析穫得區分NICP與ACS最佳,臨界值點(Cut-off值).IMA、cTnI、CK-MB及ECG結果分彆與最終診斷結果(NICP,ACS)進行綜閤分析,評價其診斷ACS的敏感性.結果 ACS組與NICP組IMA值分彆是(89.66±25.82)、(46.79±17.20)U/ml,2組間比較IMA值差異有統計學意義(P＜0.05);ROC麯線下麵積0.935,最佳臨界值為71.6 U/ml,此時IMA檢測的敏感性、特異性、暘性預測值和陰性預測值分彆為90.6%、71.4%、82.8%和83.3%.而同步測定cTnI、CK-MB、ECG診斷ACS的暘性率分彆為29.3%、27.6%、48.3%.結論 IMA是診斷急性心肌缺血早期靈敏指標,可明顯提高ACS早期診斷的敏感性.
목적 탐토결혈수식백단백(IMA)대급성관상동맥종합정(ACS)적조기진단개치.방법 103례의사ACS환자[비심기결혈성흉통(NICP)45례(NICP조),ACS 58례(ACS조)]재흉통발작5 h내취혈측정IMA、기개단백I(cTnI)、기산격매동공매MB(CK-MB)병재입원후즉각묘기12도련심전도(ECG),동시선택30례건강대조(대조조)진행검측,경ROC곡선분석획득구분NICP여ACS최가,림계치점(Cut-off치).IMA、cTnI、CK-MB급ECG결과분별여최종진단결과(NICP,ACS)진행종합분석,평개기진단ACS적민감성.결과 ACS조여NICP조IMA치분별시(89.66±25.82)、(46.79±17.20)U/ml,2조간비교IMA치차이유통계학의의(P＜0.05);ROC곡선하면적0.935,최가림계치위71.6 U/ml,차시IMA검측적민감성、특이성、양성예측치화음성예측치분별위90.6%、71.4%、82.8%화83.3%.이동보측정cTnI、CK-MB、ECG진단ACS적양성솔분별위29.3%、27.6%、48.3%.결론 IMA시진단급성심기결혈조기령민지표,가명현제고ACS조기진단적민감성.
Objective To discuss the value of ischemia modified albumin (IMA) in the early diagnosis of acute coronary syndrome (ACS). Methods The IMA,cTnI, CK-MB and ECG were detected in 103 patients with suspected ACS (45 cases of NICP and 58 cases of ACS) within 5 hours of acute chest pain onset respectively. 30 healthy subjects were served as normal controls. Receiver operating characteristic (ROC) analysis was used to determine the optimal cutoff of this assay for identifying individuals with ACS from non-ischemic individuals (nonischemic chest pain, NICP). Results of IMA,cTnI,CK-MB and ECG were correlated with the final diagnosis and their diagnostic sensitivities for ACS were evaluated. Results The results suggested that acute phase IMA values between those with ACS and NICP were (89.66 ± 25.82) U/ml, (46.79 ± 17.20) U/ml respectively and showed significant difference. Area under the curve (AUC) of the ROC was 0.935. As the Cut-off point was 71.6 U/ml, the sensitivity, specificity, PPV and NPV of IMA were 90.6%, 71.4% , 82.8% and 83.3%, respectively. The simutanious positive rate of IMA for ischemia origin were 29.3% of cTnI,27.6% of CK-MB and 48.3% of ECG(P＜ 0.01). Conclusions Plasma IMA assessment is valuable for early diagnosis of acute coronary ischemia, and will improve the early diagnostic sensitivity of ACS significantly.
