Clinical Siginificance Of Ischemia-Modified Albumin In Diagnosis Of Cardiac Ischemia Associated To Chronic Kidney Disease

ObjiectiveTo evaluate ischmia-modified albumin in patients with chronic kidney as an early marker of myocardial ischemia value.MethodsOne hundred CKD non-dialysis patients CKD(Ⅱ-Ⅴ)were choosed, according to the diagnostic criteria of myocardial ischemia, divided into two groups: myocardial ischemia 50 cases,non-myocardial ischemia group 50 cases .IMA level were detected by albumin–cobalt binding test (ACB). Serum creatinine,hemoglobin, albumin were detected ,and compared with healthy control group. IMA level were retest after receiving the best medical treatment, campared with that before treatment . Receiver operating characteristic curveanalysis was used to determine the optimal cutoff value of ACB for identifing cardiac ischemia from nonischemia individuals. The correlation of IMA and SCr,Hb were analyzed by multiple linear correlation analysis.Results1.The ACB value of CKD group with cardiac ischemia[(77.44±9.10)U/ml]was significantly lower than that of the CKD group without cardiac ischemia[(92.12±6.57)U/ml]and that of normal individuals([99.52±3.62)U/ml]. The ACB value of CKD group without cardiac ischemia also lower than that of normal individuals.2.A cutoff value of ACB value of 90.5U/ml was found by ROCcurve analysis.The AUC was 0.948.The sensitivity and specificity of this cutoff valiue to identify the patients of cardiac ischemia were 96% and 79% , respectively .Positive likelihood ratio and negative likelihood ratio were 4.571 and 0.190.3.The ACB value in CKD group with cardiac ischemia was significant difference before and after the drug therapy{[77.44±9.1)U/ml] vs([91.34±6.18)U/ml] },P<0.001.4. The ACB value in CKD group without cardiac ischemia was also significant difference before and after the drug therapy { [(92.12±6.57)U/ml] vs[(99.86±3.62)U/ml] }, P<0.001.5. Multiple linear correlation analysis showed a positive value correlated of SCr and IMA , negatively correlated of Hb and IMA.ConclutionsACB test can be applied for determination of serum IMA levels indirectly, ACB prompted the lower value the higher the level of IMA. This study shows ACB value in CKD myocardial ischemia group were significantly lower than that in non myocardial ischemia group and the normal control group, reflecting the level of IMA significantly increased in patients with myocardial ischemia; ROC curve of ACB value indicate the best cutoff value to identify patients with myocardial ischemia , the diagnosis sensitivity and specificity were 96%, 79%. IMA also increased in patients of chronic kidney disease with non myocardial ischemia.Multiple linear correlation analysis showed a positive value correlated of SCr and IMA , negatively correlated of Hb and IMA. These results suggest that IMA is an effective, sensitive marker,can be used in early diagnosis of myocardial ischemia in patients with CKD. IMA level of CKD patients reduced after given best teratmeng, suggesting that the level of IMA can be used to assess the therapeutic effect.