Sharma Rajan, Gaze David C, Pellerin Denis, Mehta Rajnikant L, Gregson Helen, Streather Christopher P, Collinson Paul O, Brecker Stephen J D
Department of Cardiology, St George's Hospital, Cranmer Terrace, London, UK.
Clin Sci (Lond). 2007 Jul;113(1):25-32. doi: 10.1042/CS20070015.
The early diagnosis of myocardial ischaemia is problematic in patients with ESRD (end-stage renal disease). The aim of the present study was to determine whether IMA (ischaemia-modified albumin) increases during dobutamine stress and detects myocardial ischaemia in patients with ESRD. A total of 114 renal transplant candidates were studied prospectively, and all received DSE (dobutamine stress echocardiography). IMA levels were taken at baseline and 1 h after cessation of DSE. A total of 35 patients (31%) had a positive DSE result. Baseline IMA levels were not significantly different in the DSE-positive and -negative groups. The increase in IMA was significantly higher in the DSE-positive group compared with those with no ischaemic response (26.5 +/- 19.1 compared with 8.2 +/- 9.6 kU/l respectively; P = 0.007; where kU is kilo-units). From ROC (receiver operator charactertistic) curve analysis, the optimal IMA increase to predict an ischaemic response was 20 kU/l, with a sensitivity of 81% and a specificity of 72% [area under the curve, 0.80 (95% confidence interval, 0.44-0.94); P = 0.03]. There were 18 deaths, ten of which were cardiac in nature over a follow up period of 2.25 +/- 0.71 years. An increase in IMA > or = 20 kU/l was associated with significantly worse survival (P = 0.02). In conclusion, IMA is a moderately accurate marker of myocardial ischaemia in ESRD. Patients with an increase in IMA > or = 20 kU/l during DSE had significantly worse survival.
终末期肾病（ESRD）患者的心肌缺血早期诊断存在问题。本研究的目的是确定缺血修饰白蛋白（IMA）在多巴酚丁胺负荷试验期间是否升高，并检测ESRD患者的心肌缺血情况。前瞻性地研究了总共114名肾移植候选者，他们均接受了多巴酚丁胺负荷超声心动图（DSE）检查。在基线时以及DSE结束后1小时测定IMA水平。共有35名患者（31%）的DSE结果为阳性。DSE阳性和阴性组的基线IMA水平无显著差异。与无缺血反应的患者相比，DSE阳性组的IMA升高显著更高（分别为26.5±19.1与8.2±9.6 kU/l；P = 0.007；其中kU是千单位）。根据受试者工作特征（ROC）曲线分析，预测缺血反应的最佳IMA升高值为20 kU/l，敏感性为81%，特异性为72% [曲线下面积，0.80（95%置信区间，0.44 - 0.94）；P = 0.03]。在2.25±0.71年的随访期内有18例死亡，其中10例为心源性死亡。IMA升高≥20 kU/l与生存率显著降低相关（P = 0.02）。总之，IMA是ESRD中心肌缺血的一个中等准确性的标志物。DSE期间IMA升高≥20 kU/l的患者生存率显著更差。
