Department of Internal Medicine, National Cheng Kung University, Tainan, Taiwan.
Clin Chem Lab Med. 2011 Nov;49(11):1817-21. doi: 10.1515/CCLM.2011.675. Epub 2011 Aug 19.
Ischemia-modified albumin (IMA), measured by the cobalt-binding capacity of albumin, is a promising biomarker for cardiac ischemia. The IMA-to-serum albumin ratio (IMAR) has been reported to relate to the severity of decompensated liver cirrhosis. This study aimed to assess IMA and IMAR as a liver function test and to investigate whether albumin infusion changes IMAR in patients with liver cirrhosis.
Blood samples were collected from healthy volunteers (n=51) and patients with chronic hepatitis (n=25), liver cirrhosis (n=24) and uremia (n=13). Parameters examined included serum levels of IMA, albumin, total bilirubin, creatinine, international normalized ratio (INR), model for end-stage liver disease (MELD) score, child-turcotte-pugh (CTP) score, indocyanine green (ICG) retention rate and total antioxidant capacity (TAC). Paired serum samples from patients pre- and post-albumin infusion (n=9) were collected and the changes were compared.
IMA and IMAR increased in patients with chronic hepatitis or cirrhosis, as compared to healthy volunteers. In patients with liver disease, IMA and IMAR were significantly associated with ICG retention, bilirubin, TAC and INR. In addition, IMAR was associated with CTP and MELD score in patients with cirrhosis. Albumin therapy improved patients' serum levels of creatinine and bilirubin and MELD score, but not IMA and IMAR.
IMAR, reflecting liver function and oxidative stress, is a more objective liver function test as it was not affected after a 3-day albumin infusion. More investigations, however, are needed to validate the use of IMAR in cases of chronic liver disease.
通过测定白蛋白与钴的结合能力来测量的缺血修饰白蛋白（IMA），是一种有前途的心肌缺血生物标志物。IMA 与血清白蛋白的比值（IMAR）已被报道与失代偿性肝硬化的严重程度有关。本研究旨在评估 IMA 和 IMAR 作为肝功能测试，并研究白蛋白输注是否会改变肝硬化患者的 IMAR。
采集健康志愿者（n=51）、慢性肝炎患者（n=25）、肝硬化患者（n=24）和尿毒症患者（n=13）的血样。检查的参数包括血清 IMA、白蛋白、总胆红素、肌酐、国际标准化比值（INR）、终末期肝病模型（MELD）评分、Child-Turcotte-Pugh（CTP）评分、吲哚菁绿（ICG）滞留率和总抗氧化能力（TAC）。从白蛋白输注前后的患者（n=9）采集配对血清样本，并比较变化。
与健康志愿者相比，慢性肝炎或肝硬化患者的 IMA 和 IMAR 增加。在肝病患者中，IMA 和 IMAR 与 ICG 滞留、胆红素、TAC 和 INR 显著相关。此外，在肝硬化患者中，IMAR 与 CTP 和 MELD 评分相关。白蛋白治疗改善了患者的血清肌酐和胆红素及 MELD 评分，但未改善 IMA 和 IMAR。
反映肝功能和氧化应激的 IMAR 是一种更客观的肝功能测试，因为它在 3 天的白蛋白输注后没有受到影响。然而，需要进一步的研究来验证 IMAR 在慢性肝病中的应用。
