Dawie Jelal, Chawla Ragender, Worku Yeshak, Azazh Aklilu
Department of Biochemistry, Faculty of medicine, Addis Ababa University.
Ethiop Med J. 2011 Jan;49(1):25-33.
Diagnosis of cardiac ischemia in patients attending emergency department with symptoms of acute coronary syndrome (ACS) is often difficult. Biochemical tests like cardiac troponin (cTnI/T) and CK-MB may not rise during reversible myocardial ischemia. Previous reports suggest that oxidative damage due to ischemic conditions rapidly modifies human serum albumin and reduce its capacity to bind exogenous cobalt. Ischemia modified albumin (IMA) has shown to be a sensitive and early biochemical marker.
To validate the use of IMA albumin as a diagnostic test for ischemic heart disease and compare its efficacy with CK-MB and cTnI.
Four sequential samples from 25 patients admitted to MICU, TASH were tested for IMA. Thirty addiional samples from healthy volunteers were assayed to establish the reference range of IMA. Patients were classified as AMI and non-AMI groups based on the clinical presentation, ECG and echocardiography findings. Colorimetrically assayed parameters included: total protein, albumin, urea, creatinine, CKT and IMA.
High number of male patients with old age were diagnosed as having AMI. Mean IMA levels were increased in patients with ACS compared to the control group and patients with Non-AMI. The mean +/- SEM value of IMA for the patient group was 83.0 +/- 6.6, which is significantly higher (p = 0.0001) than the control group with mean IMA 26.0 +/- 1.2. IMA has demonstrated a sensitivity and specificity of 100% and 85.3% respectively, and an area under the receiver operator characteristics (ROC) curve as 0.948 (95% confidence interval (CI): 0.914-0.983. The overall efficacy of IMA in differentiating AMI from Non-AMI cases appears to be comparable to that of CK-MB and cTnI.
The IMA Test can be assayed by simple and quick method, which may serve as a useful diagnostic tool for the assessment of myocardial ischemia/infarct.
对于因急性冠状动脉综合征（ACS）症状前往急诊科就诊的患者，心脏缺血的诊断往往很困难。在可逆性心肌缺血期间，心肌肌钙蛋白（cTnI/T）和肌酸激酶同工酶（CK-MB）等生化检测指标可能不会升高。先前的报告表明，缺血状态导致的氧化损伤会迅速改变人血清白蛋白，并降低其结合外源性钴的能力。缺血修饰白蛋白（IMA）已被证明是一种敏感的早期生化标志物。
验证IMA白蛋白作为缺血性心脏病诊断试验的用途，并将其与CK-MB和cTnI的疗效进行比较。
对入住塔什干重症监护病房（MICU）的25例患者的四个连续样本进行IMA检测。对另外30例健康志愿者的样本进行检测，以确定IMA的参考范围。根据临床表现、心电图和超声心动图检查结果，将患者分为急性心肌梗死（AMI）组和非AMI组。比色法检测的参数包括：总蛋白、白蛋白、尿素、肌酐、肌酸激酶（CKT）和IMA。
大量老年男性患者被诊断为AMI。与对照组和非AMI患者相比，ACS患者的平均IMA水平升高。患者组IMA的平均±标准误值为83.0±6.6，显著高于对照组的平均IMA 26.0±1.2（p = 0.0001）。IMA的敏感性和特异性分别为100%和85.3%，受试者操作特征（ROC）曲线下面积为0.948（95%置信区间（CI）：0.914 - 0.983）。IMA在区分AMI和非AMI病例方面的总体疗效似乎与CK-MB和cTnI相当。
IMA检测可通过简单快速的方法进行，可作为评估心肌缺血/梗死的有用诊断工具。
