CAJ | 학술논문

　　目的探讨缺血修饰白蛋白（IMA）在急性冠状动脉综合征（ACS）早期诊断中的价值。方法152例ACS患者（ACS组）包含不稳定型心绞痛患者（UA，n=66），ST段抬高急性心肌梗死患者（STEMI，n=51）及非ST段抬高心肌梗死患者（NSTEMI，n=35），依据发病至采血标本的时段不同将ACS组分为＜2h组（n=63）、2～4h组（n=48）及＞4h组（n=41）。检测静脉血IMA、肌钙蛋白I（cTnI）、肌红蛋白（Myb）、肌酸激酶同功酶（CK- MB）水平，并记录18导联体表心电图，并与同期因胸痛或上腹痛就诊的40例患者进行对照分析。结果 ACS组IMA水平显著高于对照组（t=10.378，P＜0.01），STEMI者均显著高于UA者（t=4.103，P＜0.01）和NSTEMI者（t=3.342，P＜0.01）。＞4h组患者血清IMA水平均显著低于＜2h组（t=5.387，P＜0.01）和2～4h组（t=5.214，P＜0.01）。IMA+心电图测定，＜2h、2～4h、＞4h亚组的阳性率均为100%，与心电图和IMA测定差异均无统计意义（χ2=0.204，P＞0.05；χ2=0.000，P＞0.05）。IMA对ACS诊断的阳性率94.1%，阳性预测值为100%，阴性预测值为100%；IMA联合心电图对ACS诊断的阳性率96.1%，阳性预测值为100%，阴性预测值为100%。结论 ACS早期血清IMA显著升高，STEMI者均显著高于UA和NSTEMI者，与心电图、传统的心肌损伤指标比较，具有更高的阳性率。
　　목적탐토결혈수식백단백（IMA）재급성관상동맥종합정（ACS）조기진단중적개치。방법152례ACS환자（ACS조）포함불은정형심교통환자（UA，n=66），ST단태고급성심기경사환자（STEMI，n=51）급비ST단태고심기경사환자（NSTEMI，n=35），의거발병지채혈표본적시단불동장ACS조분위＜2h조（n=63）、2～4h조（n=48）급＞4h조（n=41）。검측정맥혈IMA、기개단백I（cTnI）、기홍단백（Myb）、기산격매동공매（CK- MB）수평，병기록18도련체표심전도，병여동기인흉통혹상복통취진적40례환자진행대조분석。결과 ACS조IMA수평현저고우대조조（t=10.378，P＜0.01），STEMI자균현저고우UA자（t=4.103，P＜0.01）화NSTEMI자（t=3.342，P＜0.01）。＞4h조환자혈청IMA수평균현저저우＜2h조（t=5.387，P＜0.01）화2～4h조（t=5.214，P＜0.01）。IMA+심전도측정，＜2h、2～4h、＞4h아조적양성솔균위100%，여심전도화IMA측정차이균무통계의의（χ2=0.204，P＞0.05；χ2=0.000，P＞0.05）。IMA대ACS진단적양성솔94.1%，양성예측치위100%，음성예측치위100%；IMA연합심전도대ACS진단적양성솔96.1%，양성예측치위100%，음성예측치위100%。결론 ACS조기혈청IMA현저승고，STEMI자균현저고우UA화NSTEMI자，여심전도、전통적심기손상지표비교，구유경고적양성솔。
Objective To investigate the value of ischemia modified albumin (IMA)in early diagnosis of acute coro-nary syndrome (ACS). Methods 66 patients with unstable angina (UA), 51 patients with ST- elevation myocardial in-farction (STEMI)and 35 patients with non- ST- elevation myocardial infarction (NSTEMI)were eligible for this study. Ac-cording to the time from heart attack to blood sampling, patients were divided into 2h group (n=63), 2~4h group(n=48) and 4h group(n=41). Serum IMA, cardiac troponin I(cTnI), myoglobin(Myb)and creatine kinase isoenzyme(CK- MB) were measured and 18- lead surface ECGs were recorded in the three groups and compared to those in control group with 40 patients referred to hospital due to pectoralgia or epigastric pain. Results IMA level was significantly higher in ACS patients than control group (t=10.378, P<0. 01), and in STEMI than in UA (t=4.103,P<0.01)and NSTEMI patients (t=3.342,P<0.01). IMA was significantly lower in 4h group than 2h group (t=5.387,P<0. 01)and 2~4h group(t=5.214, P<0. 01). The positive rate of IMA+ECG was 100%in 2h,2~4h ,4h groups, which was not significant difference from IMA or ECG alone (χ2=0.204,P>0.05;χ2=0.000,P>0.05). In the diagnosis of ACS, the positive rate, positive predictive value and negative predictive value of IMA were 94.1%, 100% and 100%, respectively, and those of IMA + ECG were 96.1%, 100%and 100%, respectively. Conclusion Serum IMA increases early in ACS, which is more significant in STEMI than UA and NSTEMI patients. The positive rate of IMA is higher than ECG and traditional cardiac biomarkers.