缺血修饰白蛋白在急性心肌缺血中的应用

目的:探讨缺血修饰白蛋白(IMA)在急性心肌缺血早期诊断、缺血严重程度、心肌坏死程度等方面的应用。方法:通过白蛋白钴结合试验,检测80例急性心肌缺血病人[包括稳定型心绞痛(SA)20例、不稳定型心绞痛(UA)21例、急性心肌梗死(AMI)早期经皮冠状动脉介入治疗组(PCI)21例、AMI择期PCI组18例]心肌缺血6h内及20例正常对照者的血清IMA水平,结合患者临床资料进行分析。结果:(1)与正常对照组相比,SA、UA、AMI早期PCI、AMI择期PCI组血清IMA均升高,为(65.59±32.08)、(93.55±24.23)、(122.78±60.47)、(146.46±40.39)、(145.44±51.87)U/ml,P均<0.05;(2)根据心电图ST段抬高或压低是否≥0.1mV将SA、UA组病人分为两组,血清IMA水平分别为:(84.49±17.05)、(147.54±41.51)U/ml,P=0.023;(3)UA组与AMI早期PCI、AMI择期PCI组分别比较,IAM水平无统计学差异。结论:IMA对于急性心肌缺血具有早期诊断意义,并可评估心绞痛病人的缺血严重程度,但IMA不是诊断AMI良好指标。     

缺血修饰白蛋白对心肌缺血的早期诊断价值

目的探讨缺血修饰白蛋白（IMA）对心肌缺血的早期诊断价值。方法分别采用白蛋白钴结合（ACB）试验、免疫组化法检测急性冠脉综合征（ACS组）、稳定型心绞痛（SAP组）患者的血清IMA及肌钙蛋白I（cTnI）,并与健康对照组进行比较。经工作特征曲线分析获得健康者与冠心病患者的最适截断值;根据IMA、cTnI及ECG结果评价其诊断ACS的敏感性。结果与对照组比较,ACS组、SAP组ACB值明显降低（P均〈0．01）,三组血清cTnI比较无统计学差异（P均〉0．05）;血清IMA、cTnI、ECG诊断心肌缺血的敏感性分别为81．67％、66．67％、16．67％。结论IMA可明显提高心肌缺血早期诊断的敏感性。     

缺血修饰白蛋白在急性心肌缺血中的应用

目的:探讨缺血修饰白蛋白(IMA)在急性心肌缺血早期诊断、缺血严重程度、心肌坏死程度等方面的应用。方法:通过白蛋白钴结合试验,检测80例急性心肌缺血病人[包括稳定型心绞痛(SA)20例、不稳定型心绞痛(UA)21例、急性心肌梗死(AMI)早期经皮冠状动脉介入治疗组(PCI)21例、AMI择期PCI组18例]心肌缺血6h内及20例正常对照者的血清IMA水平,结合患者临床资料进行分析。结果:(1)与正常对照组相比,SA、UA、AMI早期PCI、AMI择期PCI组血清IMA均升高,为(65.59&#177;32.08)、(93.55&#177;24.23)、(122.78&#177;60.47)、(146.46&#177;40.39)、(145.44&#177;51.87)U/ml,P均&lt;0.05;(2)根据心电图ST段抬高或压低是否≥0.1mV将SA、UA组病人分为两组,血清IMA水平分别为:(84.49&#177;17.05)、(147.54&#177;41.51)U/ml,P=0.023;(3)UA组与AMI早期PCI、AMI择期PCI组分别比较,IAM水平无统计学差异。结论:IMA对于急性心肌缺血具有早期诊断意义,并可评估心绞痛病人的缺血严重程度,但IMA不是诊断AMI良好指...     

多器官缺血时缺血修饰白蛋白的变化

目的：研究2个以上器官缺血时缺血修饰白蛋白（IMA）的变化及其影响因素。方法：研究对象分为正常对照组20例，心肌缺血组28例，其中急性心肌梗死（AMI）16例，不稳定型心绞痛（UA）12例和脑梗死并发肢体血管病变的脑-肢体缺血组16例。所有研究对象采用白蛋白钴结合（albumin cobalt binding，ACB）试验测定IMA的ACB值，同时测定血肌钙蛋白Ⅰ（cardiac TroponineⅠ，cTnⅠ）和氧分压（PaO2）。结果：对照组IMA的ACB值为72．68±5．51（U／ml），心肌缺血组IMA的ACB值为52．98±7．30（U／ml），脑-肢体缺血组IMA的ACB值为54．60±9．40（U／ml），两组与对照组比较均有显著性差异（P〈0．01）。脑-肢体缺血组IMA的ACB值与PaO2之间呈正相关（r=0．986，P〈0．01）。结论：IMA是一个灵敏的缺血性标志物，既可用于预报心肌缺血，也是心外多器官缺血、缺氧性病变的佐证。IMA在作为ACS的诊断指标时要排除心外器官的缺血、缺氧因素的影响。     

缺血性修饰白蛋白在急性冠脉综合征患者中的改变及临床意义

目的观察缺血修饰白蛋白(IMA)在急性冠脉综合征(ACS)患者中的变化及临床意义。方法选择本院166例ACS患者,其中不稳定型心绞痛(UA)68例,ST段抬高急性心肌梗死(STEMI)56例,非ST段抬高心肌梗死(NSTE-MI)42例,在入院后30min内采静脉血检测其IMA水平,并与40例正常对照组进行比较分析。结果 ACS组血清IMA水平显著高于对照组[(69.71±11.56)U/ml vs(42.91±7.54)U/ml,P<0.01],STEMI组均显著高于UA组[(76.27±11.91)U/ml vs(65.05±9.25)U/ml,P<0.01]和NSTEMI组[(76.27±11.91)U/ml vs(68.53±10.56)U/ml,P<0.01],血清IMA水平与年龄无相关性(ACS组r=-0.07,对照组r=-0.11,两组联合r=-0.05;均P>0.05),对照组IMA的阴性率为100%,ACS患者中阳性预测值为100%,阳性率为89.2%,其在UA、STEMI和NSTEMI组中的阳性率分别为97.10%、85.70%和81.00%,本组中阴性预测值为69%。结论血清IMA显著升高对诊断ACS有一定的临床价值。     

急性冠脉综合征患者血清缺血修饰白蛋白的检测及意义

检测90例急性冠脉综合证(ACS)患者及35例健康对照组血清缺血修饰白蛋白(IMA)水平,结果ACS患者胸痛发作2h时血清IMA水平明显升高,并达高峰,4h时持续升高,6h时下降至正常范围.胸痛发作2、4h时不稳定型心绞痛(UAP)、非ST段抬高心肌梗死(NSTEMI)、ST段抬高心肌梗死(STEMI)患者血清IMA水平明显高于正常对照组(P<0.05,<0.01);UAP组血清IMA水平明显高于NSTEMI组和STEMI组(P<0.05).认为IMA可作为诊断ACS的早期敏感生化标志物.     

IMA、P选择素和hs-CRP联合检测对早期诊断不稳定型心绞痛的作用研究

目的探讨高敏C反应白蛋白(hs-CRP)、P选择素和缺血修饰白蛋白(IMA)联合检测在早期诊断不稳定型心绞痛(UA)诊断中的应用价值。方法对因急性胸痛发作5 h内就诊患者,从中选取怀疑为UA的患者测定其血中hs-CRP、P选择素及缺血修饰白蛋白(IMA)的浓度,并对疑似UA患者行冠状动脉造影术以确诊UA,评价三者联合诊断不稳定型心绞痛的敏感性。结果急性胸痛发作5 h内就诊患者与健康受试者血中hs-CRP、P选择素和IMA差异有统计学意义(P0.05)。hs-CRP、P选择素及IMA单独或两两联合,与三者联合诊断UA的敏感性差异有统计学意义(P0.05)。结论 IMA、P选择素和hs-CRP联合检测可对不稳定型心绞痛的早期诊断有重要价值,且能提高对不稳定型心绞痛的诊断率。     

急性心肌梗塞溶栓前后缺血性修饰白蛋白峰值的变化

目的:观察缺血性修饰白蛋白(IMA)在急性心肌梗塞(AMI)溶栓前后峰值的变化及临床意义。方法:41例AMI溶栓患者均于溶栓前,溶栓后即刻、2h、4h、6h采血检测IMA;根据溶栓结果分为再通组(23例)和未再通组(18例),比较两组溶栓后IMA值及溶栓后IMA的峰值情况。并与32例健康者IMA值做比较。结果:AMI两组(再通组、未再通组)患者溶栓前IMA值均高于正常对照者[(69.015±2.818)U/ml:(68.718±3.224)U/ml:(45.444±3.541)U/ml,P0.01];溶栓再通组患者IMA于溶栓后再次出现升高,于2h达到高峰,而未再通组IMA值呈逐渐下降趋势,再通组IMA值均显著高于未再通组(P均0.01),分别为:溶栓后2h[(73.332±3.569)U/ml:(64.359±3.431)U/ml]、4h[(70.541±2.712)U/ml:(60.655±3.267)U/ml]、6h[(64.756±3.914 U/ml):(57.573±3.863)U/ml]。结论:缺血性修饰白蛋白有望成为提示心梗后溶栓再通的一个指标。     

急性冠脉综合征患者血清缺血修饰白蛋白的变化及其临床意义

目的 对照组,UA组与AMI组间血清IMA值无差异;冠脉单支病变组血清IMA值显著低于冠脉三支病变组;冠脉Gemini积分＜20分组血清IMA值显著低于＞40分组;UA和NSTEMI患者低危组血清IMA值显著低于高危组.结论 IMA有可能作为诊断无心肌细胞坏死急性心肌缺血和反映心肌缺血严重程度的标记物.     

缺血修饰白蛋白在老年急性冠状动脉综合征中的应用价值

目的探讨缺血修饰白蛋白(IMA)在老年急性冠状动脉综合征(ACS)早期诊断中的应用价值。方法收集急诊老年患者共153例作为病例组,年龄>65岁,入选患者均有胸痛、呼吸困难、或恶心呕吐上腹不适等典型(或不典型)症状的疑似ACS,所有患者在就诊即刻、12 h抽血检测IMA、肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白T(cTnT),入院后常规查18导联心电图(ECG)、心脏彩色B超、胸部X线、腹部彩色B超和冠状动脉造影。随机选择同期在本院进行健康体检的健康者80例作为对照组,空腹抽血检测IMA水平。分别评价IMA、cTnI、ECG指标对老年ACS患者缺血早期诊断的敏感度和特异度以及三者联合应用对ACS患者缺血早期诊断的敏感度和特异度。评估IMA对老年急性冠状动脉综合征的危险分层的应用价值。结果 153例病例中,12 h cTnT阳性86例,最终诊断ACS 95例,95例包括急性ST抬高心肌梗死(STEMI)36例、急性非ST抬高急性心肌梗死(NSTEMI)48例、不稳定型心绞痛(UA)11例、非ACS 58例;来诊即刻IMA对12 h cTnT阳性及最终诊断ACS的敏感度[95.3%(82/86)、96.8%(92/95)]、阴性预测值[92.7%(51/55)、94.5%(52/55)]最高,cTnT即刻的敏感度[26.7%(23/86)、25.3%(24/95)]、阴性预测值[50.8%(65/128)、44.5%(57/128)]很低,ECG对12 h cTnT阳性及最终诊断ACS的敏感度[40.7%(35/86)、41.1%(56/67)]、阴性预测值[52.3%(56/107)、47.7%(51/107)],3个指标联合应用对12 h cTnT阳性及最终诊断ACS的敏感度[98.8%(85/86)、97.9%(93/95)]、阴性预测值[98.1%(50/51)、96.1%(49/51)],在4组中ACS组IMA明显高于非ACS组且有统计学意义,AMI组高于UA组且有统计学意义(均为P<0.05)。结论 IMA在急症患者中对ACS的早期诊断和鉴别诊断应用价值很高,对危险分层有应用价值。     

Holter-detected myocardial ischemia. Impact for prognosis and decision making after acute myocardial infarction

BACKGROUND: Aim of the study was to evaluate the prognostic and decision making value of Holter detected myocardial ischemia after acute myocardial infarction in comparison with clinically detected postinfarction angina and exercise test. METHODS: To this aim the patients consecutively admitted to our coronary care unit with acute myocardial infarction during one year were retrospectively evaluated. One hundred and eighty-nine patients (age 70+/-11 years, 137 male and 51 female) had a 24 hour Holter monitoring. One-year follow up of these patients was obtained. RESULTS: Myocardial ischemia was detected by Holter monitoring in 21 patients (11%), 4 with and 17 without angina. Symptom limited exercise test was obtained before discharge in 116 patients (62%): 45% were positive, 42% non-diagnostic and 13 negative for myocardial ischemia. Post infarction angina was present in 15 patients (9%). Patients with Holter detected myocardial ischemia were older (73+/-10 vs 66+/-11 years, p<0.05) and had higher prevalence of both angina and positive exercise test (p<0.01). One-year follow up was obtained in 186 patients. Holter detected myocardial ischemia positive predictive value for death or reinfarction was 15%, negative predictive value was 90%, similar to the absence of angina (90%) and the absence of positive exercise test (93%). Angina and exercise test identified 62% of patients with Holter detected myocardial ischemia. Residual myocardial ischemia was exclusively observed by Holter monitoring in 4% of the population, particularly in 1 patients with and 7 without exercise test. CONCLUSIONS: The additive contribution of Holter detected myocardial ischemia in the prognosis and decision making of post infarction patients is rather scanty.     

Change of plasma leukotriene c4 during myocardial ischemia in humans

Changes in leukotriene C4 levels during different degrees of myocardial ischemia in humans were examined by comparing radioimmunoassay measures of leukotriene C4 plasma levels obtained during transient and prolonged myocardial ischemia. Leukotriene C4 levels in systemic arterial and coronary sinus blood were determined in patients with chronic stable angina before and after myocardial ischemia induced either by exercise (supine bicycle ergometer exercise stress testing; n = 14; age, 52 ± 8 years) or by coronary occlusion during angioplasty (n = 14; age 53 ± 7 years). Temporal changes of leukotriene C4 were also followed in arterial and pulmonary artery blood within 24 h after the onset of chest pain (acute phase), and 1 day, 1 week, and 1 month later in 22 patients with acute myocardial infarction (AMI) (12 patients with thrombolytic therapy, age 61 ± 10 years; 10 patients without thrombolytic therapy, age 60 ± 11 years). Clinical characteristics, including coronary risk factors and the severity of coronary artery disease, were not significantly different among the groups. Exercise-induced myocardial ischemia and coronary occlusion did not induce any significant leukotriene C4 changes in the chronic stable angina patients, whereas AMI patients had significantly higher plasma leukotriene C4 levels in both arterial and pulmonary artery blood in the acute phase compared with those of chronic stable angina patients (arterial blood, 471 ± 164 pg/ml and 477 ±235 pg/ml vs. 275 ± 254 pg/ml or 240 ± 66 pg/ml, p< 0.05; pulmonary artery blood in AMI, 543 ± 162 pg/ml vs. 234 ± 125 pg/ml or 225 ±64 pg/ml, coronary sinus blood in chronic stable angina, p < 0.05). These results suggest that leukotriene C4 is involved more in prolonged myocardial ischemia than in transient myocardial is chemia, and that leukocyte function might play a significant role in the pathogenesis of patients with AMI.     

Comparison of silent and symptomatic ischemia during exercise testing in men

OBJECTIVE: To compare angina and ST-segment depression during exercise testing, as markers for coronary artery disease. DESIGN: Retrospective analysis of exercise test responses and cardiac catheterization results. SETTING: A U.S. Veterans Affairs medical center. PATIENTS: Four hundred and sixteen men who were referred for the evaluation of symptoms, postmyocardial infarction testing, or both. Two hundred patients had no clinical or electrocardiographic evidence of previous myocardial infarction, whereas 216 were survivors of a previous myocardial infarction. INTERVENTIONS: All patients did a standard exercise test and had diagnostic coronary angiography with ventriculography within an average of 32 days (range, 0 to 90 days) of their exercise test. RESULTS: Two hundred patients without a previous myocardial infarction were divided into four groups: the no ischemia group had 80 patients; the angina pectoris only group had 23 patients; the silent ischemia group had 40 patients; and the ST-segment depression and angina pectoris group had 57 patients. In patients without a previous myocardial infarction, exercise-induced ST-segment depression was a better marker than exercise-induced angina for the presence of any coronary artery disease (P less than 0.005). Patients with symptomatic exercise-induced ischemia had a higher prevalence of severe coronary artery disease than did those with only silent ischemia (30% compared with 20%; 95% CI, - 7.3% to 27.0%; P = 0.005). For the 216 survivors of a myocardial infarction, divided into the same four groups, ST-segment depression again was a better marker for the presence of severe coronary artery disease compared with angina alone (P = 0.08). The prevalence rates of severe coronary artery disease in the no ischemia plus myocardial infarction group, the angina pectoris only plus myocardial infarction group, the silent ischemia plus myocardial infarction group, and the ST-segment depression and angina pectoris plus myocardial infarction group were 10%, 9%, 23%, and 32%, respectively (P less than 0.01). CONCLUSIONS: Exercise-induced ST-segment depression is a better marker for coronary artery disease than is exercise-induced angina. Symptomatic ischemia during the exercise test is a better marker for severe coronary artery disease than is silent ischemia.     

胸痛6h内缺血修饰白蛋白对急性心肌梗死预后的价值研究

目的探讨胸痛6 h内缺血修饰白蛋白(IMA)对急性心肌梗死(AMI)预后的预测价值。方法收集武汉大学人民医院心血管内科2009年10月至2010年4月确诊为AMI患者85例。所有患者于胸痛6 h内测定IMA和心脏肌钙蛋I(cTnI),按照指南进行标准化治疗。随访6个月内心血管事件的发生情况。根据心血管事件的发生与否进行分组,分为心血管事件组和无心血管事件组。结果 85例患者中,80例随访有效,其中心血管事件组19例(23.75%),无心血管事件组61例(76.25%),心血管事件组的血清IMA高于无心血管事件组[(107.34±14.04)U/mL对(86.9±12.27)U/mL,P<0.01]。对其他心血管危险因素进行校正后,IMA仍然是心血管事件的独立危险因素(OR=1.64,95%CI:1.2~2.14,P=0.01)。结论胸痛6 h内的IMA对急性心肌梗死患者6个月心血管事件有很好的预测作用。     

The recognition of acute coronary ischemia in the outpatient setting

Background The missed diagnosis of acute myocardial infarction has been studied in the Emergency Department, but few studies have investigated how often coronary ischemia is correctly identified in the outpatient setting. Methods This was a single center retrospective observational study of patients with Health Alliance Plan medical insurance hospitalized at a US tertiary center with acute myocardial infarction in 2004. Outpatient encounters in the 30 days preceding acute myocardial infarction were reviewed by two independent cardiologists for presenting symptoms and diagnostic decision-making in order to classify patient presentations as acute coronary ischemia, stable angina or neither. Results There were 331 patients with acute myocardial infarction, including 190 (57%) with a primary diagnosis of AMI and evaluated by a physician in the preceding 30 days. This group included 68 patients with 95 documented outpatient encounters by a primary care physician, cardiologist, or other internal medicine specialist which formed the final study population. Mean interval between these encounters and AMI was 17 ± 11 days. Of these patients, 7 (10%) had symptoms of acute coronary ischemia, 5 (7%) had stable angina symptoms, and 56 (83%) had no symptoms of coronary ischemia at their outpatient encounters. Of the 7 patients with acute coronary ischemic symptoms, 5 were correctly identified and 2 were misidentified. Conclusion A majority of patients with subsequent AMI visit an outpatient provider in the month preceding AMI. However, few present with symptoms of coronary ischemia in the outpatient setting (10%) and these symptoms are not always identified as such.     

Intracellular neutrophil myeloperoxidase is reduced in unstable angina and acute myocardial infarction,but its reduction is not related to ischemia

Objectives. This study sought to assess neutrophil activation in acute coronary syndromes and its relation to ischemic episodes.Background. Neutrophil activation has been reported in unstable angina and acute myocardial infarction; however, it is not clear whether it is related exclusively to ischemia-reperfusion injury.Methods. We measured the index of intracellular myeloperoxidase in 1) patients with unstable angina, myocardial infarction, variant angina and chronic stable angina and in normal subjects (protocol A); and 2) in patients with unstable angina and acute myocardial infarction during the first 4 days of the hospital period (protocol B). To assess whether neutrophil activation was triggered by ischemia, the myeloperoxidase intracellular index was analyzed before and after spontaneous ischemic episodes and before and after ischemia induced by an exercise stress test in 10 patients with chronic stable angina. In 11 patients with unstable angina, we also compared values of the myeloperoxidase intracellular index at entry with those after waning of symptoms.Results. In protocol A, the myeloperoxidase intracellular index was significantly reduced in patients with unstable angina and acute myocardial infarction compared with patients with stable and variant angina and normal subjects (p < 0.01). In protocol B, the myeloperoxidase intracellular index did not change over time in patients with unstable angina and myocardial infarction. However, in 11 patients with waning symptoms, the myeloperoxidase intracellular index was significantly higher after symptoms had waned (p < 0.05). In patients with unstable angina, 23 ischemic episodes were studied; no changes in the myeloperoxidase intracellular index were observed. In 10 patients with chronic stable angina and positive exercise stress test results, no significant differences in the myeloperoxidase intracellular index were observed after stress-induced ischemia.Conclusions. Our study confirms that neutrophils are activated in acute coronary syndromes but suggests that their activation may not be only secondary to ischemia-reperfusion injury.     

Reduced albumin-cobalt binding with transient myocardial ischemia after elective percutaneous transluminal coronary angioplasty: a preliminary comparison to creatine kinase-MB, myoglobin, and troponin I

BACKGROUND: Previous reports suggest that ischemic conditions rapidly reduce the capacity of human albumin to bind exogenous cobalt. A new assay based on human albumin-cobalt binding (ACB) may help detect early myocardial ischemia. We investigated altered ACB during the first 24 hours after transient ischemia induced during elective percutaneous transluminal coronary angioplasty (PTCA). We then compared ACB assay results with creatine kinase isoenzyme (CK-MB), myoglobin, and cardiac troponin I (cTn-I) values after PTCA. METHODS AND RESULTS: In 41 patients undergoing elective PTCA, plasma samples were tested for the ACB assay, CK-MB, myoglobin, and cTn-I before, immediately after, and 6 and 24 hours after PTCA. Thirteen additional patients served as a control group with albumin-cobalt assays performed before and after diagnostic coronary catheterization without angioplasty. ACB assay results demonstrated a significant mean percent difference (10.1%) immediately after PTCA compared with baseline (P < .000001) and returned to baseline by 6 hours after PTCA. ACB assay differences immediately after PTCA were significantly greater than in the control group (10.1% vs -0.9%, P < .001). Mean CK-MB, myoglobin, and cTn-I values were not elevated above baseline immediately after PTCA but were significantly elevated above baseline 6 and 24 hours after PTCA. CONCLUSIONS: These preliminary results suggest that human albumin undergoes a significant reduction in its capacity to bind exogenous cobalt soon after transient coronary occlusion during human PTCA and before significant elevations of CK-MB, myoglobin, or cTn-I. Further confirmatory investigations are warranted to determine if the ACB assay is a useful diagnostic test for early myocardial ischemia.     

缺血修饰白蛋白在冠心病临床应用的研究进展

缺血修饰白蛋白(IMA)是血清白蛋白在经历缺血后形成的一种新的较理想的缺血标志物,对心肌损伤的诊断有较高的敏感性,检测技术成熟,检验方法简易快捷,成本不高.多项临床实验研究显示,IMA在冠心病领域中,特别是在急性冠状动脉综合征的诊断、危险分层以及治疗方案的制订中具有重要意义.另有一些研究提示:IMA可能对接受经皮冠状动脉介入术的冠心病患者预后有一定预测价值;IMA在冠状动脉痉挛诱发的短暂心肌缺血中也可能有一定意义;IMA水平可能与心功能的分级有一定的相关性.IMA作为一个优秀的心肌缺血指标,还需要更深入的研究以确定它在冠心病领域中广阔的临床应用价值.     

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。