Emergency Center, Xinhua Hospital, Shanghai Jiaotong University, Shanghai 200092, China (Pan SM, Lin Q, Zhao J); Emergency Department, Zhongshan Hospital,Fudan University,Shanghai 200032,China (Tong CY, Yao CL, Deng Z).
World J Emerg Med. 2010;1(1):37-40.
Patients with acute chest pain remain a great diagnostic challenge to emergency physicians. Ischemia-modified albumin (IMA) is a recently developed biomarker of transient myocardial ischemia. IMA has already been licensed by the US Food and Drug Administration for diagnosis of suspected myocardial ischemia. This study aimed to assess the diagnostic value of IMA in treatment of patients with acute coronary syndrome(ACS).
IMA level was detected by ultra-filtration assay combined with albumin-cobalt binding (ACB) test as well as tests of myoglobin (MYO), creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) in 169 consecutive patients with acute chest pain onset within 24 hours. Receiver operating characteristic (ROC) curve for IMA in diagnosing ACS was established to determine the cut-off point. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IMA and its combinations with other agents were analyzed.
Area under the ROC curve (AUC) was 0.754. As the cut-off point for IMA in this study was 70.4 U/ml, the sensitivity, specificity, PPV and NPV of IMA were 79.8%, 65.2%±77.7%, and 69.7%, respectively. The sensitivity and NPV of IMA combined with the conventional cardiac marker panel for the diagnosis of ACS were 93.4% and 86.0%, respectively.
IMA is a useful biochemical marker for the early diagnosis of ACS. IMA combined with the conventional cardiac marker panel can improve early diagnosis of ACS compared with the traditional combinations of myocardial biochemical markers.
急性胸痛患者仍然是急诊医生面临的巨大诊断挑战。缺血修饰白蛋白（IMA）是一种新开发的短暂性心肌缺血生物标志物。IMA 已获得美国食品和药物管理局（FDA）的许可，用于诊断疑似心肌缺血。本研究旨在评估 IMA 在急性冠状动脉综合征（ACS）患者治疗中的诊断价值。
采用超滤法联合白蛋白-钴结合（ACB）试验及肌红蛋白（MYO）、肌酸激酶同工酶-MB（CK-MB）和心肌肌钙蛋白 I（cTnI）检测 169 例急性胸痛患者（胸痛发作时间在 24 小时内）的 IMA 水平。建立 IMA 诊断 ACS 的受试者工作特征（ROC）曲线，确定截断点。分析 IMA 及其与其他标志物联合的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
ROC 曲线下面积（AUC）为 0.754。以本研究中 IMA 的截断点为 70.4 U/ml，IMA 的敏感性、特异性、PPV 和 NPV 分别为 79.8%、65.2%±77.7%和 69.7%。IMA 联合常规心脏标志物检测 panel 诊断 ACS 的敏感性和 NPV 分别为 93.4%和 86.0%。
IMA 是 ACS 早期诊断的有用生化标志物。IMA 联合常规心脏标志物 panel 可提高 ACS 的早期诊断率，优于传统心肌生化标志物组合。
