| Objective:As a new clinical biochemical marker, ischemia modified albumin (IMA) was determined by albumin cobalt bindin test (ACB), according to the decreasing bonding force between N-extremity of human serum albumin (HSA) and cobaltion. Acute coronary syndrome (ACS) are the clinical common disease at present, it has max hazard to human health because of its high morbidity, high mutilation rate, high case fatality, so we design the study in order to prove that it is important to make early diagnosis to ACS and acute cerebrovascular disease and we can make early intervention pretreatment to it. The study hints us:to determine the level of IMA within 6h of Acute chest pain, and compare with the level of IMA of control group, to survey variance of the level of IMA, then we can know the value of early diagnosis to ACS, To approach whether there is relation between the level of IMA and coronary artery affection degree; to survey variance of the level of IMA of ACS before and after the operation of percutaneous coronary intervention, to estimate the clinical value of IMA in diagnosing ACS.Methods:The subjects are elected from department of cardiology 2006.Sep～2007.Jun, The hospital Affiliated to North China Coal Medical College, and Tang Shan workers'Hospital, which diagnosis ACS. All the subjects are taken suction when they admission, and done ECG. Altogether 95 cases, men 68 cases, women 27 cases, age from 34~79, mean age (61.52±11.04). All patients are diagnosed ACS retrospectively by coronary arteriongraphy prior to discharge. The ACS group are divided into unstable angina pectoris (58 cases) and acute myocardial infarction (37 cases). At the same time,to elect 52 in-patients as the control group which excluded coronary artery disease through coronary arteriongraphy, men 29 cases, women 23 cases age from 35~58, mean age (51.54±6.41). I myself complete the questionnaire after make face to face style, including the general state of health and the morbility, diagnosis, therapia and complication of the subjects, write down the blood fat series, serum glucose, hepat-renal function, albumin etc. All patients are diagnosed ACS retrospectively by coronary arteriongraphy. To make coronary arteriongraphy with Jundkins method. To utilize multi-site digital subtraction radiography with iohexol as constrast medium. To analyze the disease of coronary by two salty cardia-internists. To deploy the major coronary (left bole, anterior descending branch, convolution, auricular artery), to amount stenosis branches with≥50%.Coronary artery affection degree is evaluated by Gensini method.The patients of ACS blood samples were taken blood sample 5ml before and after PCI on 5minutes and 24h. The blood sample is not hematocytolysis, no EDTA, natrium citricum et al. they are cohesion after collection in ordinary temperature. Centrifugation blood-serum, to ensure there is no fibrin, RBC and other particle. To keep the blood sample in -70℃within 1h. the blood sample was determined IMA,cTnI by the same professional staff of laboratory with automatic biochemistry analyzer of HITACHI-7600. To sort data with Excel, data processing with SPSS11.5. The index of normal distribution data by mean (value±standard) ( x±s) deviation expression. To analyses the datum withχ2 test, t test, analysis of variance, rank correlation. It has significance in statistic with P<0.05. To plot with Excel.Result:1. The IMA level of ACS and control group is (89.10±20.91)u/ml,(46.42±11.43)u/ml, it is statistics meaning in difference of IMA level between the two groups by t test (P<0.05). It is no statistics meaning (P>0.05) between UAP and AMI group with the difference of the IMA level.2. In ACS group, the IMA level of the patients after the PCI 10 minutes compare with pre-PCI, It is statistics meaning in difference of IMA level between the two groups(P<0.01); The IMA level after the PCI 6h and 24h compare with pre-PCI, It is no statistics meaning in difference of IMA level between the three groups (P>0.05); Compare with the IMA level after the PCI 6 hours and 24 hours, it is statistics meaning in difference of IMA level between the two groups (P<0.05).But the cTnI level of the patients after the PCI 10 minutes compare with pre-PCI, it is no statistics meaning in difference of cTnI level between the two groups(P>0.05); The cTnI level after the PCI 6h and 24h compare with pre-PCI, It is statistics meaning in difference of cTnI level between the three groups (P<0.05); Compare with the cTnI level after the PCI 6 hours and 24 hours, it is no statistics meaning in difference of cTnI level between the two groups (P>0.05).3. According to the results of coronary art eriongraphy, to determine IMA level of Coronary artery affection one ramus affection, two rami affection, three rami affection, it is statistics meaning (P<0.05) among them by analysis of variance. It is no statistics meaning (P>0.05) between two rami and three rami affection, but it is statistics meaning P<0.05) with one ramus affection in IMA.4. It is statistics meaning (r=0.040,P>0.05) between the IMA level and Gensini integration by interclass correlation.5. It is masculine when IMA>64.7u/ml,cTnI>1.68mg/L, to compare the sensitive of diagnosing ACS by IMA,cTnI alone. Application IMA,cTnI diagnosing ACS for the sensitive (90.5%vs37.9%),the specificity (84.6% vs96.2%),the negative predictive value (83.0%vs45.9%), they are all statistics meaning (P<0.05); Compare with IMA,cTnI(91.5%vs94.7%) for the positive predictive value to ACS, it is no statistics meaning (P>0.05) between them. In UAP group, the sensitive (89.7%vs15.5%),the specificity (84.6%vs96.2%),the negative predictive value (88.0%vs50.5%) by application IMA,cTnI to diagnose UAP, they are all statistics meaning (P< 0.05);Compare with IMA(89.7%),cTnI (81.8%) for the positive predictive value to UAP, it is no statistics meaning (P>0.05) between them. In AMI group, the sensitive (91.9%vs73.0%),the specificity(84.6%vs96.2%),the positive predictive value (81.0%vs93.1%)by application IMA,cTnI to diagnose UAP, they are all statistics meaning (P<0.05);Compare with IMA(93.6%),cTnI (83.3%) for the negative predictive value to UAP, it is no statistics meaning (P>0.05) between them.Conclusion:1. The level of IMA has something dependence with Coronary artery affection degree, IMA cannot accurate reflect Coronary artery affection degree in ACS.2. The level of IMA will increase when ACS and after the operation of PCI, it is earlier than cTnI, it will be go down to the basal line level after 24h.3. Compare with the cTnI, IMA has higher sensibility after occurred ACS within 6h, but the specificity is less than cTnI. |
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