CAJ | 학술논문

目的：探讨缺血修饰性白蛋白（ischemia modified albumin ，IMA）、高敏C反应蛋白（high -sensitivity C -reactive protein ，hs -CRP）及肌钙蛋白I （cardiac troponin I ，cTnI）检测对急性冠脉综合症（acute coronary syndrome ，ACS）患者早期诊断的意义。方法：选取192例在胸痛3小时内就诊的患者，分别即时和在3-6小时内抽取两次静脉血，检测血清IMA、hs-CRP及cTnI水平；并根据最终的临床诊断分组，其中130例ACS患者入选ACS组，62例排除ACS的胸痛患者入选对照组即非缺血性胸痛组（NICP）；比较两组患者在胸痛3小时内和3-6小时两个时间段IMA、hs-CRP及cTnI的水平。并分别评价在胸痛早期单独或联合应用对ACS早期诊断的敏感性和特异性。结果：在胸痛发作3小时内，ACS组的IMA、hs -CRP水平已显著高于NICP组，并有显著性差异（p＜0．05），而cTnI水平两组并无显著性差异（p＞0．05），而在胸痛发作的3-6小时内，ACS组的cTnI、IMA、hs-CRP均显著高于NICP组，并有显著性差异（p＜0．05）。在胸痛发作3小时内，单独应用IMA诊断 ACS的敏感性为86．15％，特异性为79．49％，准确性为82．13％；高于应用 hs -CRP或cTnI单独诊断 ACS的敏感性（分别为53．84％，34．62％），及准确性（分别为61．23％，57．29％）但特异性低于 cTnI（91．18％）。IMA 联合cTnI或 hs -CRP二联与单独应用 IMA相比，灵敏度和准确度显著提高，各组中 IMA 联合cTnI和 hs -CRP三联的灵敏度、准确度最高。结论：血清 IMA 是ACS发病早期心肌缺血的敏感指标，可能优于cTn I和 hs -CRP对 ACS发病早期的心肌缺血诊断作用。联合检测 IMA、hs -CRP及 cTn I可以提高诊断的敏感度，对指导临床早期诊断 ACS有一定价值。
목적：탐토결혈수식성백단백（ischemia modified albumin ，IMA）、고민C반응단백（high -sensitivity C -reactive protein ，hs -CRP）급기개단백I （cardiac troponin I ，cTnI）검측대급성관맥종합증（acute coronary syndrome ，ACS）환자조기진단적의의。방법：선취192례재흉통3소시내취진적환자，분별즉시화재3-6소시내추취량차정맥혈，검측혈청IMA、hs-CRP급cTnI수평；병근거최종적림상진단분조，기중130례ACS환자입선ACS조，62례배제ACS적흉통환자입선대조조즉비결혈성흉통조（NICP）；비교량조환자재흉통3소시내화3-6소시량개시간단IMA、hs-CRP급cTnI적수평。병분별평개재흉통조기단독혹연합응용대ACS조기진단적민감성화특이성。결과：재흉통발작3소시내，ACS조적IMA、hs -CRP수평이현저고우NICP조，병유현저성차이（p＜0．05），이cTnI수평량조병무현저성차이（p＞0．05），이재흉통발작적3-6소시내，ACS조적cTnI、IMA、hs-CRP균현저고우NICP조，병유현저성차이（p＜0．05）。재흉통발작3소시내，단독응용IMA진단 ACS적민감성위86．15％，특이성위79．49％，준학성위82．13％；고우응용 hs -CRP혹cTnI단독진단 ACS적민감성（분별위53．84％，34．62％），급준학성（분별위61．23％，57．29％）단특이성저우 cTnI（91．18％）。IMA 연합cTnI혹 hs -CRP이련여단독응용 IMA상비，령민도화준학도현저제고，각조중 IMA 연합cTnI화 hs -CRP삼련적령민도、준학도최고。결론：혈청 IMA 시ACS발병조기심기결혈적민감지표，가능우우cTn I화 hs -CRP대 ACS발병조기적심기결혈진단작용。연합검측 IMA、hs -CRP급 cTn I가이제고진단적민감도，대지도림상조기진단 ACS유일정개치。
Objective To explore the values of the detecting of ischemia modified albumin (IMA) ,high -sensitivity C -reactive protein (hs-CRP) and cardiac troponin I (cTnI) in diagnosis of the early acute coronary syndrome (ACS) patients .Methods A total of 192 patients who were admitted to hospital in 3 hours after chest pain occurred were recruited and divided into non -ischemic chest pain group (NICP n=62) and acute coronary syndrome group (ACS n=130) ,Serum IMA ,hs-CRP and cTnI were detected in the three hours and the period be-tween three to six hours after chest pain occurred and compared between the two groups .Results When chest pain was happened in three hours ,the levels of serum IMA and hs -CRP in ACS group were increased significantly compared with the control group (all P<0 .05) ,the levels of cTnI was no stastical significance between groups( P>0 .05) .However ,three to six hours after chest pain happened ,the levels of serum IMA ,hs -CRP and cTnI in ACS group were increased significantly compared with the control group (all P<0 .05) .The sensitivity , specificity ,accuracy were 86 .15% ,79 .49% and 82 .13% of the IMA in a separate early diagnosis ;were significantly high than the sensitivity of hs -CRP or cTnI(53 .84% and 34 .62% respectively) and the accuracy of hs -CRP or cTnI(61 .23% and 57 .29% respectively) ,howev-er ,the specificity of cTnI in a separate early diagnosis was significantly high than the other two .The sensitivity and accuracy will increases significantly when combination of IMA with cTnI or hs -CRP .The sensitivity and accuracy were the highest when combined IMA ,cTnI and hs-CRP together .Conclusion IM A ,is a sensitive marker of early ACS ,w hich probably better than hs -CRP and in the early diagnosis of ACS .Combination of IMA ,cTnI and hs -CRP will increase the sensitivities of diagnosis .