缺血修饰白蛋白在急性ST段抬高型心肌梗死再灌注疗效评价中的价值

目的探讨血清缺血修饰白蛋白(IMA)在急性ST段抬高型心肌梗死(STEMI)患者心肌缺血再灌注早期的变化及评价心肌缺血再灌注疗效的应用价值。方法纳入160例急性STEMI并行急诊经皮冠状动脉介入(PCI)治疗的患者,根据PCI术后90 min心电图上ST段回落情况分为ST段完全回落组(ST段回落≥70%,n=92)和ST段不完全回落组(ST段回落70%,n=68)。检测两组患者术前及术后30min血清IMA浓度,计算PCI前后IMA的变化(δIMA),同时检测术前及术后4 h,8 h,12 h,24 h血清肌钙蛋白(cTnI)峰值,术后第二天血清hs-CRP水平。δIMA与ST段回落程度的相关性采用Pearson相关性检验,δIMA对术后ST段回落程度的预测价值通过受试者工作特征曲线(ROC)下面积来评估。结果与ST段完全回落组比较,ST段不完全回落组血清δIMA的水平显著升高(P0.01),cTnI峰值及hs-CRP水平也显著升高(P0.05),δIMA与ST段回落程度的相关系数r=0.525(P0.01)。以δIMA=19.505U/ml为截点,对预测ST段完全回落的阳性预测值为77.2%,阴性预测值为69.1%,受试者工作特征曲线下面积为0.794(95%CI:0.723~0.865,P0.01)。结论对STEMI并行PCI的患者,其再灌注早期血清IMA的变化能较好的预测心电图ST段的回落幅度,IMA作为早期缺血损伤指标是评估心肌缺血再灌注治疗效果的早期敏感指标。

Value of ischemia modified albumin to curative effect reviewing in treatment of acute ST-segment ;elevation myocardial infarction and reperfusion

Objective To discuss the early changes and value of ischemia modified albumin （IMA） to curative effect reviewing in treatment of myocardial ischemia and reperfusion in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods The STEMI patients （n=160） treated with acute PCI were chosen and divided into completed group （ST-segment resolution≥70%, n=92） and incompleted group （ST-segment resolution〈70%, n=68） according to ST-segment resolution on ECG 90 min after PCI. The level of serum IMA was detected in two groups before and after PCI, and variation of IMA （δIMA） were calculated. The peak value of cTnI before and after PCI for 4 h, 8 h, 12 h and 24 h, and serum hs-CRP level on the 2nd d after PCI were detected. The correlation betweenδIMA and ST-segment resolution degree was verified by using Pearson correlation test. The predictive value ofδIMA to ST-segment resolution degree was reviewed with area under ROC curve. Results The level of serum IMA increased significantly （P〈0.01） and cTnI peak value and hs-CRP level increased significantly （P〈0.05） in completed group compared with incompleted group （r=0.525, P〈0.01）. When takingδIMA=19.505 U/ml as cutoff point, the positive predictive value to complete ST-segment resolution was 77.2%and negative predictive value was 69.1%. The area under ROC curve was 0.794 （95%CI：0.723-0.865, P〈0.01）. Conclusion The early changes of serum IMA can predict ST-segment resolution degree in the patients with STEMI treated with PCI, which can be taken as an early sensitive index for reviewing curative effect on myocardial ischemia and reperfusion.