摘要目的：探讨3种血清心肌损伤标志物缺血修饰清蛋白（IMA）、N 末端脑钠肽前体（NT-proBNP）及超敏肌钙蛋白 I（TnI-Ultra）联合检测对急性冠状动脉综合征（ACS）的临床诊断价值。方法选取80例冠状动脉造影明确诊断 ACS 患者（ACS 组），选择同期80例健康体检者（对照组）。检测所有研究研究对象血清的 IMA、NT-proBNP、TnI-Ultra。并记录 ACS 患者胸痛发作时间，比较胸痛＜3 h 内者与3～6 h 间者血清的IMA、NT-proBNP、TnI-Ultra 的变化，并计算3项指标单独检测和联合检测对 ACS 诊断的敏感度、特异度、准确度。结果ACS 组患者血清 IMA（92．45±9．78）mmol／L、NT-proBNP（2106±678）pg／mL 及 TnI-Ultra（4．08±1．01）ng／mL 均显著性高于对照组 MA（71．44±8．34）mmol／L、NT-proBNP（235±108）pg／mL 及 TnI-Ultra （0．04±0．02）ng／mL（t ＝14．62、25．08、35．77，均 P ＜0．05）。UA、NSTEMI、STEMI 患者血清 IMA（97.79±12.67）mmol／L、（88．34±11．05）mmol／L 和（86．73±12．36）mmol／L、NT-proBNP（976±138）pg／mL、（2344±878）pg／mL 和（5068±1450）pg／mL，TnI-Ultra（0．15±0．06）ng／mL、（1．76±1．03）ng／mL，（18．67±1．34）ng／mL比较差异有统计学意义（F ＝10．89、29．08、40．33，均 P ＜0．05）；且 NSTEMI、STEMI 患者血清 NT-proBNP 及TnI-Ultra 均显著高于 UA 患者（均 P ＜0．05）；STEMII 患者血清 NT-proBNP 及 TnI-Ultra 均显著高于 NSTEMI 患者（均 P ＜0．05）。胸痛小于3 h、胸痛3～6 h 患者血清 IMA（91．88±11．07）mmol／L，（95．70±10．89）mmol／L、NT-proBNP（1807±970）pg／mL，（2456±1346）pg／ml 及 TnI-Ultra（0．33±0．08）ng／mL，（7．68±1．36）ng／mL均显著高于对照组（71．44±8．34）mmol／L，（235±108）pg／mL，（0．04±0．02）ng／mL（均 P ＜0．05）；胸痛小于3～6 h 患者血清 IMA、NT-proBNP 及 TnI-Ultra 均显著高于胸痛小于3 h（均 P ＜0.05）。IMA、NT-proBNP 及TnI-Ultra 联合检测的阳性率为95．0％（76／80）。联合检测的阳性率显著性高于单独检测的阳性率 IMA、NT-proBNP 及 TnI-Ultra 85．0％（68／80）、75．0％（60／80）、72．5％（58／80）（P ＜0．05）。结论IMA、NT-proB-NP、CTnI 三者联合检测有利于提高 ACS 的早期诊断的敏感度和准确性，且检测周期短，操作简便，值得临床推广。

abstractsObjective To discuss the clinical value of using three markers including ischemia modified albu-min (IMA),N terminal brain natriuretic peptide precursor (NT -proBNP)and allergic troponin I (TnI -Ultra)in diagnosis of acute coronary syndromes (ACS).Methods 80 ACS patients diagnosed by coronary artery imaging were selected,and meanwhile 80 healthy people were chosen as the control group.The serum IMA,NT -proBNP and TnI -Ultra were recorded and compared.The changes of IMA,NT -proBNP and TnI -Ultra in all ACS patients the chest pain onset time,chest pain <3h within and between 3 -6h serum were recorded and compared;And sensitivity,specif-ic and accuracy diagnosis in ACS of the three separate tests and joint detection were compared.Results In ACS patients,serum IMA,NT -proBNP and TnI -Ultra were all significantly higher than those in the control group (t =14.62,25.08,35.77,all P <0.05).In UA,NSTEMI,STEMI patients,serum IMA,NT -proBNP and TnI -Ultra all had statistically significant differences (F =10.89,29.08,40.33,all P <0.05);And in NSTEMI,STEMI patients, serum NT -proBNP and TnI -Ultra were significantly higher than those in patients with UA (all P <0.05 );In STEMII patients,serum NT -proBNP and TnI -Ultra were significantly higher than those in the NSTEMI patients (all P <0.05).In patients chest pain less than 3h,chest pain patients'serum IMA,3 -6h NT -proBNP and TnI -Ultra&nbsp;were significantly higher than those in the control group (all P <0.05);In chest pain less than 3 -6h patients,serum IMA,NT -proBNP and TnI -Ultra were significantly higher than those in chest pain less than 3h patients (all P <0.05).The positive detection rate of IMA,NT -proBNP and TnI -Ultra joint detection was 95.0% (76 /80),which was significantly higher than that of the single detection (P <0.05 ).Conclusion IMA,NT -proBNP and CTnI combined detection could significantly improve the sensitivity and accuracy of the early diagnosis of ACS,which testing cycle is short and easy to operate,worthy of clinical promotion.