Evaluation on ischemia-modified albumin，D-dimer and cTnI in the early diagnosis of acute coronary syndrome

Abstract

Objective To investigate the early diagnosis value of IMA and D-dimer and cTnⅠin ACS. Methods All the 113 blood samples of patients with chest pain in the emergency department of the Third Hospital of Hebei Medical University were selected.Thirty healthy people were selected as the control group.Patients were divided into two groups：one of 52 cases was within 3 hours after onset of chest pain, the other of 61 cases was between 3 to 6 hours.According to the final clinical diagnosis, 31 cases were divided into non-ischemic chest pain group (NICP) and 82 cases were divided into the ACS group.The ACS group was divided into the UA group (51 cases), NSTEMI group (18 cases) and STEMI group (13 cases).IMA was measured with albumin-cobalt binding test, and D-dimer was measured with the automated blood coagulation analyzer, and cTnⅠ was measured with the automatic biochemical analyzer.Levels of IMA, D-dimer, cTnⅠwere compared in the different groups and their sensitivity, specificity and accuracy to the early diagnosis of ACS were evaluated by Four format diagnositic test. Results The levels of IMA in ACS group, which include the UA group, NSTEMI group and STEMI group were （0.722±0.181），（0.601±0.122），（0.631±0.153） ABSU respectively .The levels of D-dimer were （0.485±0.124），（0.571±0.181），（0.748±0.094） mg/L respectively.The levels of cTnⅠ were （0.076±0.027），（0.059±0.038），（0.065±0.015） μg/L respectively.Concentrations of IMA, D-dimer and cTnⅠin ACS group were significantly higher than those of the NICP group ［IMA （0.338±0.065） ABSU, D-dimer （0.368±0.078） mg/L, cTnⅠ （0.022±0.007） μg/L］ and the controls group ［IMA （0.292±0.058） ABSU, D-dimer （0.267±0.052） mg/L, cTnⅠ （0.029±0.016） μg/L］.There were significant differences between the ACS group and the NICP group and the control group, F value was 3.613，3.289 and 3.521 respectivily, and P<0.05.The levels of IMA in ACS group within 3 hours and between 3 to 6 hours, which is （0.665±0.104），（0.520±0.073） ABSU, were significantly higher than that of the controls (0.292±0.058) ABSU (F value was 3.58, P<0.05).The levels of D-dimer and the cTnⅠ in the group between 3 to 6 hours ［which were （0.634±0.213） mg/L and （0.079±0.032） μg/L］ were significantly higher than those of the controls ［（0.267±0.052） mg/L and （0.029±0.016） μg/L］ (q was 4.24 and 3.46, P<0.05).The sensitivity, specificity and accuracy was 83.36%, 70.97% and 81.42% of the IMA in a separate diagnosis of ACS, but the sensitivity, specificity and accuracy were 97.56%, 58.06% and 86.73% of the IMA, D-dimer and cTnⅠ with the affiliation diagnosis. Conclusion The serum IMA is a more sensitive indicator of ACS in early myocardial ischemia than cTnⅠ and plasma D-dimer.Serum IMA in combination with D-dimer and cTnⅠ could improve the sensitivity and specitivity, and had value to guide cinical diagnosis of ACS in the early stage.（Chin J Lab Med，2012,35：443-447） Key words: Acute coronary syndrome; Serum albumin; Biological markers; Troponin Ⅰ