Mongolian Health Population Ischemia Modified Albumin The Establishment Of The Reference Range And Clinical Application

Objective:To establish a detection method for IMA, and evaluate its reliability. To determine the range of biological reference of IMA from Mongolian health population; Use the receiver operating characteristic curve (receiver operating characteristic curve, ROC curve) analysis to obtain an appropriate cut-off value, and further evaluation of the applied value of IMA in the early acute coronary syndromes patients (Acute Coronary Syndromes, ACS)in the process of making diagnosis..Methods:Employed albumin cobalt test (produced by Technology Development Co., Ltd. Changsha), optimized parameters on the HITACHI 7600 automatic biochemical analyzer. The establishment of albumin cobalt binding capacity (albumin cobalt binding, ACB) colorimetric assay for detection of IMA system refers to the Committee for Clinical Laboratory Standards (National Committee for clinical Laboratory Standards, NCCLS) EP documentation requirements. Evaluated the precision, linearity, and recovery of the testing system. Selected 592 healthy volunteers in our hospital as well as Chifeng Medical Examination Center in November 2008-December 2009, from urban, rural, are pastoral workers, farmers, students, workers, cadres, aged from 18 to 75 years for the Mongolian and Han nationalities (male 294, female 298,236 Mongolian, Han 356, mean age 44.75±1.3.81 years old), Measured the serum IMA level and established the Mongolian health population IMA biological reference range; Continuously collected 303 patients (male 196 cases, age 58.98±11.78 years; Female 107, age 65.7±10.5 years) from Nov.2008 to Dec.2009 because of "chest tightness, chest pain," sustained attack for more than 5 minutes and hospitalized within 3 hours. All patients admitted were immediately tested for venous blood IMA, cardiac troponin I (cardiac troponin I, cTnI), the monitor 12-lead electrocardiogram (electrocardiogram, ECG), accept the standard diagnosis and treatment, and the process was not effected by measured values of IMA. According to the final diagnosis of ACS patients were divided into ACS group of 172 cases (male 117 cases,55 females, aged 62.16±11.03 years) and non-ischemic chest pain (non-ischemia chest pain, NICP) group of 131 cases (male 79, female 52 patients, aged 60.31±12.65 years). Construct the selected patients (ACS group and the NICP group) levels of serum IMA ROC curve. Analysis of ROC curve distinguished ACS and the NICP optimal detection threshold, and the early diagnosis of ACS sensitivity, specificity, positive predictive value (positive predictive value, PPV), negative predictive value (negative predictive value, NPV). Made IMA, cTnI and ECG alone or in combination with the final diagnosis of the correlation analysis, comparing IMA, cTnI and ECG alone or in combinationto make sure the sensitivity of early diagnosis of ACS.Make further evaluation of IMA in the early diagnosis of ACS value.Results:We established the ACB colorimetric determination of high, medium and low 3 different concentrations of IMA specimens the coefficient of variation (coefficient of variation, CV) were 1.67%,1.13%, 3.34% and between coefficient of variation (CV) were 1.88%,1.63%, 3.72%. Determination of different concentrations of human serum albumin results are linear regression equation Y= 1.676X+6.735 (r= 0.983, P= 0.001). The average recovery of recovery test was 97%. The mean serum IMA level of 592 cases of healthy people in Inner Mongolian region was 70.51±3.04U/ml, the average level of serum IMA has no significant difference among nationalities, gender groups, and different age groups (P all> 0.05), IMA levels in healthy population of Mongolian side 95% reference range> 66.23U/ml. ACS Group mean serum IMA level of 56.10±4.19U/ml, significantly lower than NICP group (68.28±5.8) and healthy control group (70.51±3.04), (P<0.05). Construction of selected patients (ACS group and the NICP group) ROC curves of IMA level, ROC area under the curve 0.929,95% confidence interval (95% confidence interval, CI) was 0.897-0.962. According to ROC curve analysis we can obtain an optimal distinction between ACS and the NICP detection threshold= 60.30 U/ml, with a sensitivity of 91.3%, specificity was 86.3%, positive predictive value (PPV) was 89.7%, negative predictive value (NPV) was 88.3%. IMA, cTnI, ECG, cTnI+ECG, IMA+cTnI, IMA+ECG, IMA+cTnI +ECG alone or in combination the sensitivity of early diagnosis of ACS were:91.3%,43.0%,52.9%,55.8%,92.4%,94.8%,98.8%.Conclusions:(1) ACB colorimetric assay IMA, the indicators are in line with the clinical laboratory management requirements, the establishment of relatively simple experimental conditions, samples and reagent consumption, rapid detection, a large number of samples can be measured, it is a simple scientific and economical experimental methods.It is suitable for clinical application of conventional promotion. (2) between the Mongolian and Han nationality, gender groups, different age groups the average level of serum IMA has no significant difference in Mongolian healthy population reference range of serum IMA Biology> 66.23U/mL. (3) IMA can be used for suspected ACS patients with acute chest pain patients to make early diagnosis and NICP discharge diagnosis, hospital stay was reduced, saving medical resources as well, improve the emergency physician for the diagnosis and treatment of patients with chest pain. (4) Combined detection of IMA, cTnI, and ECG can improve the detection rate of ACS and improve sensitivity, reduce the rate of misdiagnosis.