Sbarouni Eftihia, Georgiadou Panagiota, Panagiotakos Demosthenes, Alivizatos Petros A, Voudris Vassilis
2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Biomarkers. 2009 Feb;14(1):38-42. doi: 10.1080/13547500902730706.
Any increase of cardiac biomarkers after coronary artery bypass grafting (CABG) indicates myocyte necrosis and is likely to be related to an impaired outcome. We investigated whether ischaemia-modified albumin (IMA), a biomarker of ischaemia, is also raised following CABG.
We studied 50 stable consecutive patients undergoing elective isolated CABG on cardiopulmonary bypass, of whom 46 were men and four women, aged 64 +/- 9 years. Blood samples were obtained the day before the operation (pre-op) as well as immediately after the operation, 24 h postoperatively (post-op) and the fourth day post-op and assayed for creatine kinase, the MB isoenzyme of creatine kinase, cardiac troponin-I, albumin and IMA.
The typical rising and falling pattern of myocardial necrosis of all three cardiac enzymes was observed post-op (p <0.0001). IMA increased significantly following CABG at all three time points (113 +/- 43, 106.7 +/- 22.6 and 110.2 +/- 12.5 U ml(-1), respectively) compared with pre-op values (91.7 +/- 10.5 U ml(-1)), (p <0.0001); the sample immediately post-op was significantly higher compared with the following samples (immediately post-op vs 24 h, p = 0.008 and immediately post-op vs 4 days, p = 0.03, with no significant difference between the last two). IMA level changes during the study course were independent of the albumin changes. Haemoglobin decreased significantly post-op (p <0.0001 vs baseline) whereas serum creatinine did not differ during the study period.
IMA increases significantly following CABG but whether or not this carries a prognostic significance remains to be elucidated.
冠状动脉旁路移植术（CABG）后任何心脏生物标志物的升高均提示心肌细胞坏死，且可能与预后不良相关。我们研究了缺血修饰白蛋白（IMA）这一缺血生物标志物在CABG后是否也会升高。
我们对50例连续接受择期体外循环下单纯CABG的稳定患者进行了研究，其中46例男性，4例女性，年龄64±9岁。在手术前一天（术前）、手术后即刻、术后24小时（术后）和术后第四天采集血样，检测肌酸激酶、肌酸激酶MB同工酶、心肌肌钙蛋白I、白蛋白和IMA。
术后观察到所有三种心脏酶的心肌坏死典型的上升和下降模式（p<0.0001）。与术前值（91.7±10.5 U ml-1）相比，CABG后IMA在所有三个时间点均显著升高（分别为113±43、106.7±22.6和110.2±12.5 U ml-1），（p<0.0001）；术后即刻样本与随后的样本相比显著更高（术后即刻与24小时，p = 0.008；术后即刻与4天，p = 0.03，后两者之间无显著差异）。研究过程中IMA水平变化与白蛋白变化无关。术后血红蛋白显著降低（与基线相比p<0.0001），而血清肌酐在研究期间无差异。
CABG后IMA显著升高，但这是否具有预后意义仍有待阐明。
