超滤法缺血修饰蛋白检测对急性冠脉综合征的早期诊断价值.doc

超滤法缺血修饰白蛋白检测对急性冠脉综合征的早期诊断价值 潘曙明，赵洁，林强，顾金花，董利军，杨旭峰 【摘要】 目的 探讨超滤法缺血修饰白蛋白(ischemia modified albumin，IMA)单独及联合心肌损伤标记物对急性冠脉综合征（acute coronary syndrome,ACS）早期诊断价值。方法 连续纳入胸痛症状发生24 h以内的急性胸痛患者150 例组成待研究人群，测定每位患者血清IMA水平及临床常用的心肌损伤标记物(Myo，CK-MB，cTnI)进行定量。通过绘制IMA在该人群中用于诊断ACS的受试者特征曲线（receiver operating characteristic curve，ROC curve)判定最佳临界值。测定IMA诊断ACS的敏感性、特异性、阳性预测值和阴性预测值，并比较不同标记物组合诊断ACS的敏感性、阳性预测值和阴性预测值。结果 ROC曲线下面积为0.821，最佳临界值为70.4 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89.5%、67.9%，80.0%和81.8%，敏感性和阴性预测值均高于cTnI，差异有高度统计学意义（P 0.01），特异性和阳性预测值差异均无统计学意义（P 0.05）。 76例ACS患者中，入院即刻IMA测值水平超过最佳临界值者68例，阳性率达89.5%，而同步测定cTnI阳性者仅42例，阳性率仅为55.3%，两者差异有显著统计学意义（P 0.01）shumingpan@ Role of ischemia-modified albumin measured with ultrafiltration in the early diagnosis of acute coronary syndromes Pan Shuming, Zhao Jie, Lin qiang, Gu jinhua, Dong lijun,Yang xufen 〔Abstract〕 Objective To investigate the accuracy of presentation ischaemia-modified albumin (IMA) measured with ultrafiltration, alone or in addition to other biochemical markers of myocardial necrosis, in early diagnosing acute coronary syndrome(ACS). Methods The IMA level, Myo，CK-MB and cTnI were detected in 150 consecutive patients with acute chest pain onset within 24 hours. Receiver operating characteristic(ROC) curve for IMA in diagnosing ACS was established to determine the Cut-off Point. To analysis the sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of IMA and compare the sensitivity, PPV, NPV in different combinations. Results Area under the curve(AUC) of the ROC was 0.821. As the Cut-off Point was 70.4 U/ml, the sensitivity, specificity, PPV and NPV of IMA were 89.5%、67.9%，80.0% and 81.8%, respectively. The sensitivity and NPV of IMA were significantly higher compared with cardiac troponin I(cTnI)（P 0.01）,while the specificity and PPV of IMA were statistically equivalent to cTnI（P 0.05）. In 76 patients with ACS, the immediate positive rate of IMA was significantly higher compared with cT