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目的探讨缺血修饰白蛋白(IMA)对非ST抬高型急性冠脉综合征(NSTEACS)的早期诊断价值。方法 177例疑似NSTACS患者于胸痛发作6 h内采血,测定心肌肌钙蛋白(IcTnI);用间接白蛋白钴结合试验(ACB法)测定血清IMA值。且均经标准诊疗以及GRACE评分,并根据最终诊断分为NSTEMI组(n=34)、不稳定型心绞痛(UA)组(n=56)和非缺血性胸痛(NICP)组(n=87)。另随机选取本院同期行健康体检者58例作为健康对照组。通过绘制IMA诊断NSTEACS的受试者工作特征(ROC)曲线,取得判定IMA的最佳临界值。将IMA、心电图和cTnI单独或联合诊断与最终诊断进行综合分析。结果 NSTEMI组与UA组IMA水平无显著性差异;NSTEMI组、UA组与NICP组比较,其IMA水平均有显著性差异。ROC曲线下面积0.950,Cut-o值取67.49 U/mL时,诊断NSTEACS的敏感性和特异度分别为91.1%和86.2%。IMA水平与GRACE评分呈显著负相关。结论 IMA是早期诊断NSTEACS的敏感指标,并有助于判断患者的预后。
Objective To investigate the early diagnostic value of ischemic-modified albumin (IMA) in non-ST-elevation acute coronary syndrome (NSTEACS). Methods One hundred and seventy-seven patients with suspected NSTACS were admitted to the hospital within 6 hours after onset of chest pain and cardiac troponin (IcTnI) was measured. Serum IMA was measured by indirect albumin-cobalt binding assay (ACB). The patients were divided into NSTEMI group (n = 34), unstable angina pectoris group (n = 56) and non-ischemic chest pain group (n = 87) according to the final diagnosis. ). Another randomly selected hospital in the same period 58 healthy subjects as a healthy control group. The best cutoff value for IMA was obtained by plotting the receiver operating characteristic (ROC) curve of IMA to diagnose NSTEACS. The IMA, ECG and cTnI alone or in combination with the final diagnosis of a comprehensive diagnosis. Results There was no significant difference in IMA levels between NSTEMI group and UA group. There was significant difference in IMA between NSTEMI group, UA group and NICP group. The sensitivity and specificity for diagnosing NSTEACS were 91.1% and 86.2% for the area under the ROC curve of 0.950 and the Cut-o value of 67.49 U / mL, respectively. There was a significant negative correlation between IMA level and GRACE score. Conclusion IMA is a sensitive indicator of early diagnosis of NSTEACS, and help to determine the prognosis of patients.