The Study Of Ischemia Modified Albumin And CXC Chemokine Ligand 16 In The Early Diagnosis Of Patients With Acute Coronary Syndrome

Objective:To explore the values of ischemia modified albumin(IMA)and CXC chemokine ligand 16(CXCL16)in the early diagnosis of patients with acute coronary syndrome(ACS).Methods:235 patients who visited chest pain center of WuXi People's Hospital were enrolled in our research.All patients were suspected with ACS and chest pain occurred less than three hours,lasted more than fifteen minutes.According to the final diagnosis,four groups had been divided:1)group of ST-segment elevated acute myocardial infarction patients(STEMI,126 patients),2)group of non-ST-segment elevated acute myocardial infarction patients(NSTEMI,41patients),3)group of unstable angina patients(UA,36 patients),4)group of patients(NICP,32 patients).Venous blood of all patients was immediately draw on admission and 6 hours after admission.IMA was measured by the albumin cobalt binding test(ACB Test),CXCL16 was measured using enzyme-linked immunosorbent assay(ELISA).Chemiluminescence method was used for determinating the concentrations of serum cardiac troponin I(cTnI).We then perform the correlational analyses of the levels of IMA,CXCL16,cTnI at the immediate admission.We also collected the GRACE scores of all ACS patients and analyzed the correlation between GRACE score and the levels of IMA,CXCL16,cTnI at the immediate admission.Receiver Operating Characteristic(ROC)curve and area under curve(AUC)were analysed with SPSS20.0 statistical software to determine the values of IMA,CXCL16,cTnI and"IMA+CXCL16" in diagnosing ACS or NSTE-ACS.Results:1.At the immediate admission,the level of IMA in STEMI group was(79.21±40.95)U/mL,which had no statistical significance with that of NSTEMI group[(77.27±49.04)U/mL,P=0.772],but both groups had statistical significance with UA group[(57.47±15.56)U/mL]or NICP group[(47.28±16.47)U/mL](STEMI vs UA:P=0.002,STEMI vs NICP:P<0.001,NSTEMI vs UA:P=0.021,NSTEMI vs NICP:P=0.001).However,there was no statistically significant between UA group and NICP group(P=0.263).At the 6 hours after admission,The levels of IMA in STEMI group,NSTEMI group and UA group were(60.05±20.41)U/mL,(59.71±22.42)U/mL and(56.00±12.75)U/mL respectively and those three groups had no statistical significance with each other(STEMI vs NSTEMI:P=0.921,STEMI UA:P=0260,NSTEMI UA:P=0.393).The level of NICP group was(47.38112.95)U/mL,and had statistically significance with both STEMI group and NSTEMI group(STEMI vs NICP:P=0.001,NSTEMI NICP:P=0.006),had no statistically significant with UA group(P=0.062).2.At the immediate admission,the levels of CXCL16 in STEMI group,NSTEMI group and UA group were(2.37±0.79)?g/L,(2.35±0.63)?g/L,(2.14±0.61).g/L respectively and those three groups had no statistical significance with each other(STEMI vs NSTEMI:P=0.899,STEMI UA:P=0.105,NSTEMI vs UA:P=0.213).The level of NICP group was(1.78±0.61)?g/L,and had statistically significance with those three ACS groups(STEMI vs NICP:P<0.001,NSTEMI vs NICP:P=0.001,UA NICP:P=0.04).At the 6 hours after admission,the levels of CXCL16 in STEMI group,NSTEMI group,UA group and NICP group were(2.62±0.89)?g/L,(2.33±0.65)?g/L,(2.17±0.59)?g/L and(1.77±0.52)?g/L,respectively.The CXCL16 level of STEMI group was statistically significant with other three groups(STEMI vs NSTEMI:P=0.042,STEMI vs UA:P=0.003,STEMI vs NICP:P<0.001).The CXCL16 level of NSTEMI group wasn't statistically significant with that of UA group(P=0.366)and was statistically significant with that of NICP group(P=0.001).There was statistical significance between UA group and NICP group(P=0.04).3.At the immediate admission,there was no statistically significant correlation between IMA level and CXCL16 level in ACS patients(P=0.564).Both of IMA level and CXCL16 level were significant correlational with cTnI level in ACS patients(IMA vs cTnI:r=0.155,P=0.027,CXCL16 vs cTnl:r=0.466,P<0.001).Both of IMA level and CXCL16 level were not significant correlational with GRACE score(IMA GRACE:P=0.142,CXCL16 vs GRACE:P=0.086)while cTnI level was significant correlational with GRACE score in ACS patients(r=0.137,P=0.05).4.For diagnosing ACS at the immediate admission,the AUC of IMA,CXCL16,cTnI were 0.749[95%CI(0.669?0.829)],0.715[95%CI(0.623?0.807)],0.805[95%CI(0.728?0.881)]respectively and weren't statistically significant(IMA vs CXCL16:P=0.575,IMA vs cTnI:P=0.305,CXCL16 vs cTnI:P=0.161)with each other.Combining IMA and CXCL16 increased the diagnosing rate of ACS:AUC=0.806[95%CI(0.737?0.867)],which was statistically significant with that of CXCL16 alone(P=0.004),but was not statistically significant with those of IMA alone or cTnI alone(IMAA+CXCL16,vs IMA:P=0.0745 IMA+CXCL10 vs cTnI:P=0.971).5.For diagnosing NSTE-ACS at the immediate admission,the AUC of IMA,CXCL16,IMA+CXCL16,cTnI were 0.700[95%CI(0.596?0.805)],0.712[95%CI(0.603?0.821)],0.762[95%CI(0.666?0.857)],0.676[95%CI(0.568?0.783)]respectively and were not statistically significant(IMA vs CXCL16:P=0.876,IMA vs cTnI:P=0.735,CXCL16 vs cTnI:P=0.646,IMA+CXCL16 vs IMA:P=0.194,IMA+CXCL16 vs CXCL16:P=0.142,IMA+CXCL16 vs cTnI:P=0.242)with each other.Conclusions:1.The concentrations of serum IMA,CXCL16 were elevated very early in ACS patients compared those of NICP patients and serum IMA level decreased at 6 hours after admission,however the elevation of serum IMA level was last very long in ACS patients.2.At the immediate admission,Both of IMA level and CXCL16 level were significant correlational with cTnI level in ACS patients but there was no statistically significant correlation between IMA level and CXCL16 level.3.At the immediate admission,Both of IMA level and CXCL16 level were not significant correlational with GRACE score,while cTnI level was significant correlational with GRACE score in ACS patients.4.At the immediate admission,IMA or CXCL16 alone had the diagnostic value in early ACS and NSTE-ACS,Combining IMA and CXCL16 even increased the diagnosing rate of ACS and NSTE-ACS.