探讨心肌损伤标志物血清缺血修饰蛋白(IMA)、肌红蛋白(Mb)和正常对照组肌钙蛋白I(cTnI)联合检测在急性心肌梗死(AMI)早期诊断中的临床应用价值。

选择2015年1月至2017年12月于高唐县人民医院急诊科、心内科就诊且确诊为AMI的115例患者作为研究组，50例健康体检者作为正常对照组，测定研究组患者入院0.5 h、6 h、12 h后及正常对照组血清IMA、Mb和cTnI水平，并进行统计学分析，比较血清IMA、Mb和cTnI对AMI早期诊断的敏感度、特异度、准确度。通过受试者工作特征(ROC)曲线下面积(AUC)比较各指标在AMI早期诊断中的价值。

在患者入院0.5 h、6 h、12 h后，研究组血清IMA水平[(128.35±13.53)U/ml，(104.27±11.64)U/ml，(84.73±6.97)U/ml]、Mb水平[(161.83±15.64)μg/L，(311.44±40.92)μg/L，(470.45±46.81)μg/L]，cTnI水平[(0.31±0.05)μg/L，(12.56±2.73)μg/L，(74.84±6.37)μg/L]，与对照组血清IMA、Mb和cTnI水平[(32.34±3.57)U/ml，(51.47±8.53)μg/L，(0.27±0.03)μg/L]比较，均差异有统计学意义(F＝65.42，52.21，67.46；均P<0.01)。在患者入院12 h后，IMA、Mb和cTnI诊断AMI的敏感度分别为80.58%、86.65%、59.63%，特异度分别为45.14%、34.57%、88.32%，准确度分别为72.81%、75.48%、89.56%；IMA＋Mb＋cTnI联合检测的敏感度、特异度、准确度分别为74.34%、91.56%、92.69%。IMA、Mb、cTnI单项检测及IMA＋Mb＋cTnI联合检测诊断AMI的ROC曲线AUC分别为0.618，0.582，0.822，0.914，IMA＋Mb＋cTnI的AUC最大，具有较高的诊断效能，优于IMA、Mb和cTnI单项检测。

心肌损伤标志物IMA、Mb和cTnI的联合检测，可为AMI的早期诊断提供更好的参考依据，对早期排除和确定诊断AMI有重要的临床应用价值。

To explore the clinical value of combined detection of serum ischemia modified protein (IMA), myoglobin (Mb) and troponin I (cTnI) levels in the early diagnosis of acute myocardial infarction (AMI).

The research group selected 115 cases patients who were diagnosed as AMI in emergency and cardiology departments of the People′s Hospital of Gaotang County from January 2015 to December 2017. Fifty cases of healthy subjects were selected as control group. Serum IMA, Mb and cTnI levels at the time of 0.5 h, 6 h and 12 h after admission in the research group and those in the normal control group were measured, and the statistical analysis was conducted to compare the sensitivity, specificity and diagnostic coincidence rate of serum IMA, Mb and cTnI in the early diagnosis of AMI. Through the area under the receiver operating characteristic (ROC) curve (AUC) to compare the value of each index in the early diagnosis of AMI.

0.5 h, 6 h, 12 h after admission, comparing the serum IMA levels [(128.35±13.53)U/ml, (104.27±11.64)U/ml, (84.73±6.97)U/ml], Mb levels [(161.83±15.64)μg/L, (311.44±40.92)μg/L, (470.45±46.81)μg/L], cTnI levels [(0.31±0.05)μg/L, (12.56±2.73)μg/L, (74.84±6.37)μg/L] of research group, to the control group [(32.34±3.57)U/ml, (51.47±8.53)μg/L, (0.27±0.03)μg/L], the differences were statistically significant (F=65.42, 52.21, 67.46, all P<0.01). At the time of 12 h after admission, the sensitivity of IMA, Mb and cTnI were 80.58%, 86.65% and 59.63% respectively, the specificity were 45.14%, 34.57% and 88.32% respectively, the diagnostic coincidence rates were 72.81%, 75.48%, 89.56% respectively. The sensitivity, specificity and diagnostic coincidence rates of IMA+ Mb+ cTnI combined detection were 74.34%, 91.56% and 92.69% respectively. The AUC of IMA, Mb, cTnI single detection and IMA+ Mb+ cTnI combined detection for AMI diagnosis were 0.618, 0.582, 0.822, and 0.914, respectively. The AUC of IMA+ Mb+ cTnI was the largest, which had high diagnostic efficiency and was superior to the single detection of IMA, Mb and cTnI.

The combined detection of serum IMA, Mb and cTnI can provide a better reference for the early diagnosis of AMI, and has important clinical value for the early exclusion and diagnosis of AMI.