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Applied Research of Ischemia Modified Albumin for the Diagnosis of Coronary Heart Disease

Author: LiYa
Tutor: TuHong
School: Guangzhou Medical College
Course: Internal Medicine
Keywords: Ischemia Modified Albumin Treadmill test
CLC: R541.4
Type: Master's thesis
Year: 2010
Downloads: 19
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Abstract

[Objective]: by measuring the rabbit model of acute myocardial ischemia, ischemia-modified albumin (Ischemia-modified Albumin, IMA) changes in the evaluation of the diagnostic value the IMA of early myocardial ischemia; through joint detection of the IMA, exercise treadmill test (Exercise Stress Test, EST), the evaluation of IMA in the early diagnosis of coronary heart disease (Coronary Heart Disease, CHD). (3), ischemia of the [method]: 1. Experimental study of 50 New Zealand white rabbits were randomly divided into five groups: (1) 5 minutes of ischemia group 10; (2), 30 minutes of ischemia group 10; 5 minutes esmolol intervention group 10; (4), ischemia and 30 minutes group the esmolol intervention group 10; (5), sham group 10. Incomplete ligation of the left anterior descending artery, to establish myocardial ischemia model before modeling, modeling success after 15min, 30min, 1h, 2h, 4h, 8h, 12h, 24h blood collection, detection IMA, cTnI and CK-MB; sham group thoracotomy without ligation of the left anterior descending artery, blood collection time and the same way as before, according to the test results to draw the curve detection indicators. After blood collection is complete, double stained by TTC and Evans blue method determination of the ischemic area, then fixed myocardial specimens routine HE staining and TUNEL assay apoptosis index (Apoptosis Index, AI) was measured. 2 clinical trial in 60 cases of EST-positive patients, before exercise and 10 minutes after the end of the exercise, blood samples were collected to detect IMA, all patients underwent coronary angiography (Coronary Angiography, CAG) examination. Routine physical examination of healthy people 30 cases as normal controls, venous blood equipment measured IMA. Exercise treadmill test using the the Bruce program the positive standard adopted 1997AHA/ACC standard. IMA was measured by albumin - cobalt ion binding assay (Albumin Cobalt Binding, ACB), the use of automated immunoassay biochemistry analyzers. Coronary angiography standard Judkins law. Statistically SPSS16.0 statistical software for data analysis. The normal distribution of the measurement data are presented as mean ± standard deviation (χ ± s). The experimental research component IMA, of CTnI, CK-MB results using analysis of variance repeated measurement data; ischemic area and AI groups were compared using single-factor analysis of variance; between IMA and ischemic area, AI correlation analysis using Spearman correlation analysis. Independent samples t test is used to compare the clinical research part of the IMA group movement before and after comparison using a paired t-test; χ2 test was used to compare the count data group. The results take bilateral P lt; 0.05 for statistical significance. [Results]: the animal experiments 1.1 IMA of CTnI determination of CK-MB IMA 15 minutes after the onset of ischemia that is elevated (P lt; 0.01), the peak time for four hours after ischemia; ischemia between groups and between the sham group, the difference was statistically significant (P lt; 0.05); relationship between IMA and ischemic area was statistically significant (r = 0.834, P lt; 0.01); IMA and AI between correlation statistically significant (r = 0.911, P lt; 0.01). cTnI no elevated after ischemia, cTnI mean differences in each experimental group had no statistical significance (P gt; 0.05). CK-MB mean in all ischemic groups than in the sham group was increased, but there was no statistical significance (P gt; 0.05), CK-MB and between ischemic group mean difference was not statistically significant (P gt; 0.05). 1.2 Determination of the ischemic area of ??each ischemia group ischemic area compared with sham group increased significantly (P lt; 0.05); 5 minutes of ischemia and 30 minutes of ischemia, ischemic five minutes of the intervention group and 30 minutes of ischemia intervention group between the difference was statistically significant (P lt; 0.01); 5 minutes of ischemia and ischemic 5-minute intervention group, and 30 minutes of ischemia and ischemic difference between the 30-minute intervention group had statistical significance (P gt; 0.05). 1.3 AI were measured ischemia group AI higher than the sham group, and the difference was statistically significant (P lt; 0.01) between the ischemic group; AI and ischemic area exist positive correlation (r = 0.891, P lt; 0.01). 2. 2.1 angiographic results of clinical trials 60 patients, coronary angiography positive CAG () (ie vascular stenosis ≥ 50% involvement of more than one vascular No new vascular occlusion) in 41 patients (68.3%), coronary angiography negative CAG (-) (ie any a vascular stenosis lt; 50%), 19 patients (31.7%). 2.2 IMA was measured in all patients before exercise IMA value and the normal control group showed no significant difference (P gt; 0.05) after exercise IMA value was significantly higher, which CAG () patients was significantly higher than CAG (-) patients (P lt; 0.01 ), but the difference before the latter movement was no statistical significance (P gt; 0.05). 35mg/ml limit value (IMA (): ≥ 35mg/ml, IMA (-): lt; 35mg/ml), CAG () patients with IMA () 38 patients with CAG (-) patients IMA () by two cases; 35mg/ml limit value in patients with coronary heart disease IMA positive rate was 92.7%, combined IMA can improve the specificity of the diagnosis of coronary artery disease in EST, to 89.5% (P lt; 0.01). [Conclusion]: Compared with CTnI and CK-MB, IMA better earlier in myocardial reversible ischemia reflect the occurrence of myocardial ischemia and continuing status is a sensitive indicator of the reaction of early myocardial ischemia and ischemia extent; IMA value after exercise in patients with coronary heart disease was significantly higher combined IMA detection can significantly improve the specificity of treadmill exercise test in the diagnosis of coronary heart disease.

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