CAJ | 학술논문

目的通过观察不稳定型心绞痛（UAP）患者在经皮冠状动脉介入治疗术（PCI）前后血清中的缺血性修饰白蛋白（IMA）、心肌肌钙蛋白（cTnI）及肌酸激酶同功酶（CK-MB）的浓度变化，探讨IMA在UAP早期诊断与治疗中的作用，为临床UAP的早期诊断与治疗提供客观依据。方法43例研究对象均选自诊断为UAP的住院且在住院期间再次出现胸痛发作患者，其中26例为行PCI治疗的冠心病患者（研究组），同时以17例仅行诊断性冠脉造影的患者为对照组，两组患者均于术前术后0.5、6、12 h采集血样测定IMA、cTnI及CK-MB的浓度，详细记录研究组患者术中的球囊扩张的压力、时间、次数，植入支架的部位和数目，术中、术后1d的心电图变化。结果研究组有24例患者的IMA在术后0.5 h较术前明显升高（P＜0.05），术后6 h开始下降，术后12 h逐渐恢复至基线水平；而cTnI在术前、术后0.5、6 h的变化不明显，有17例患者于术后12 h升高，与其他时间段相比较差异有显著性（P＜0.05），但其CK-MB于术前及术后各时间点的变化不明显（P＞0.05），未见升高患者。而对照组患者术前、术后各时间点的IMA、cTnI及CK-MB的变化均不明显（P＞0.05）。结论 PCI术会导致心肌发生缺血缺氧损伤，且IMA在PCI术后迅速升高，且比cTnl和CK-MB的出现要早；IMA的升高与术中球囊扩张的总压力、持续时间、扩张次数呈正相关。即IMA可作为早期及PCI术后诊断UAP的一个心肌标志物。
목적통과관찰불은정형심교통（UAP）환자재경피관상동맥개입치료술（PCI）전후혈청중적결혈성수식백단백（IMA）、심기기개단백（cTnI）급기산격매동공매（CK-MB）적농도변화，탐토IMA재UAP조기진단여치료중적작용，위림상UAP적조기진단여치료제공객관의거。방법43례연구대상균선자진단위UAP적주원차재주원기간재차출현흉통발작환자，기중26례위행PCI치료적관심병환자（연구조），동시이17례부행진단성관맥조영적환자위대조조，량조환자균우술전술후0.5、6、12 h채집혈양측정IMA、cTnI급CK-MB적농도，상세기록연구조환자술중적구낭확장적압력、시간、차수，식입지가적부위화수목，술중、술후1d적심전도변화。결과연구조유24례환자적IMA재술후0.5 h교술전명현승고（P＜0.05），술후6 h개시하강，술후12 h축점회복지기선수평；이cTnI재술전、술후0.5、6 h적변화불명현，유17례환자우술후12 h승고，여기타시간단상비교차이유현저성（P＜0.05），단기CK-MB우술전급술후각시간점적변화불명현（P＞0.05），미견승고환자。이대조조환자술전、술후각시간점적IMA、cTnI급CK-MB적변화균불명현（P＞0.05）。결론 PCI술회도치심기발생결혈결양손상，차IMA재PCI술후신속승고，차비cTnl화CK-MB적출현요조；IMA적승고여술중구낭확장적총압력、지속시간、확장차수정정상관。즉IMA가작위조기급PCI술후진단UAP적일개심기표지물。
Objective By observing unstable angina pectoris (UAP) patients in the percutaneous coronary intervention therapy (PCI) of serum ischemia-modified albumin (IMA), cardiac troponin I (cTnI) and creatine kinase isoenzyme (concentration of CK-MB), and to explore the role of IMA in the UAP early diagnosis and treatment of, and provide an objective basis for the early diagnosis and treatment of clinical UAP. Methods 43 subjects were selected from a diagnosis of UAP hospitalization and recurrence of chest pain patients during hospitalization, including 26 cases of coronary heart disease patients treated with PCI (study group), while 17 cases by diagnostic coronary angiographypatients of the control group, patients in both groups before surgery postoperative 0.5, 6, 12 h collecting blood samples determination of IMA, cTnI and CK-MB concentration, a detailed record of the balloon dilatation pressure in the patients of the study group, time, number of, the location and number of stents, surgery, postoperative day ECG changes. Results Study group of 24 patients IMA was significantly higher (P<0.05) after 6 h after 0.5 h compared with the preoperative began to decline, 12 h after gradually returned to baseline levels; cTnI in the preoperative and postoperative 0.5 h, 6 h did not change significantly, 17 patients with elevated after 12 h, and other time periods and the difference was significant (P<0.05), but changes in CK-MB in the preoperative and postoperative time points not obvious (P>0.05), no increase in patients. The control group patients before, after point in time the IMA, cTnI and CK-MB changes are not significant (P>0.05). Conclusion PCI, will lead to the damage of the myocardial ischemia and hypoxia, and IMA increased rapidly after PCI, and earlier than cTnl and CK-MB appear; elevated IMA's and intraoperative balloon dilatation of the total pressure, duration, the number of expansion was positively correlated. IMA can be used as a cardiac marker of early PCI after diagnosis of UAP.