CAJ | 학술논문

目的：探讨缺血修饰白蛋白（IMA）在早期急性心肌梗死（AMI）诊断中的临床价值。方法检测126例疑似AMI的胸痛患者[其中67例最终确诊为AMI（AMI组），59例为非AMI （NAMI组）]在发病6 h内、6 h后（7～24 h）血清IMA、心肌肌钙蛋白I （cTnI）、肌红蛋白（MYO）和肌酸激酶同工酶（CK-MB）浓度，以50名无心肌疾患的健康者作为正常对照组，绘制受试者工作特征（ROC）曲线，观察IMA对AMI的诊断灵敏度及诊断效能。结果 AMI组血清IMA、cTnI、MYO和CK-MB浓度均明显高于NAMI组及正常对照组（P＜0．001），NAMI组4项指标浓度亦高于正常对照组（P＜0．001）。ROC曲线显示IMA诊断早期AMI（＜6 h）的曲线下面积（AUC）为0．851[95％可信区间（CI）：0．775～0．926]，最佳临界点为82．1 U/mL，灵敏度、特异性、阳性预测值和阴性预测值分别为82．2％、84．9％、85．9％和80．6％，灵敏度高于cTnI（50．7％，P＜0．001）、MYO（67．1％，P＜0．05）和CK-MB（20．9％，P＜0．001）。早期联合检测血清IMA、cTnI、MYO和CK-MB的阳性检出率可达92．5％。结论检测疑似AMI患者的IMA水平有助于AMI的早期临床诊断。多项心肌标志物联合检测可提高AMI的早期检出率。
목적：탐토결혈수식백단백（IMA）재조기급성심기경사（AMI）진단중적림상개치。방법검측126례의사AMI적흉통환자[기중67례최종학진위AMI（AMI조），59례위비AMI （NAMI조）]재발병6 h내、6 h후（7～24 h）혈청IMA、심기기개단백I （cTnI）、기홍단백（MYO）화기산격매동공매（CK-MB）농도，이50명무심기질환적건강자작위정상대조조，회제수시자공작특정（ROC）곡선，관찰IMA대AMI적진단령민도급진단효능。결과 AMI조혈청IMA、cTnI、MYO화CK-MB농도균명현고우NAMI조급정상대조조（P＜0．001），NAMI조4항지표농도역고우정상대조조（P＜0．001）。ROC곡선현시IMA진단조기AMI（＜6 h）적곡선하면적（AUC）위0．851[95％가신구간（CI）：0．775～0．926]，최가림계점위82．1 U/mL，령민도、특이성、양성예측치화음성예측치분별위82．2％、84．9％、85．9％화80．6％，령민도고우cTnI（50．7％，P＜0．001）、MYO（67．1％，P＜0．05）화CK-MB（20．9％，P＜0．001）。조기연합검측혈청IMA、cTnI、MYO화CK-MB적양성검출솔가체92．5％。결론검측의사AMI환자적IMA수평유조우AMI적조기림상진단。다항심기표지물연합검측가제고AMI적조기검출솔。
Objective To investigate the clinical significance of ischemia modified albumin(IMA)in the early diagnosis of acute myocardial infarction(AMI).Methods A total of 126 patients with acute chest pain were enrolled. Through the final diagnosis,67 cases were AMI(AMI group),while the other 59 cases were non-AMI (NAMI group). Their serum concentrations of IMA,cardiac troponin I(cTnI),myoglobin(MYO)and creatine kinase-MB(CK-MB) were determined respectively within or more than 6 h (7-24 h)after the onset of chest pain.A total of 50 healthy subjects without cardiac disorders were enrolled as control group.The sensitivity and diagnostic effectiveness of IMA in the early diagnosis of AMI were evaluated by receiver operating characteristic(ROC)curve.Results In AMI group,the serum levels of IMA,cTnI,MYO and CK-MB were higher than those in NAMI and control groups(P<0.001),and the serum levels in NAMI group were also higher than those in control group (P<0.001 ).The area under ROC curve (AUC)of IMA (<6 h ) was 0.85 1 [95% confidence interval (CI):0.775-0.926 ].At the optimal cut-off of 82.1 U/mL,the sensitivity,specificity,positive predictive value and negative predictive value were 82.2%,84.9%, 85.9% and 80.6%,respectively.The sensitivity of IMA was higher than that of cTnI(50.7%,P<0.001),MYO (67.1%,P<0.05)and CK-MB(20.9%,P<0.001).The positive detection rate for the combined determination of IMA,cTnI,MYO and CK-MB was 92.5% in the early diagnosis of AMI.Conclusions The determination of IMA among the suspected AMI patients has important significance in the early diagnosis of AMI.The combined determination of cardiac markers can improve the positive detection rate of AMI.