摘要：目的 探讨血清缺血修饰白蛋白（IMA）、心型脂肪酸结合蛋白（H-FABP）及尿酸（UA）与急性冠脉综合征（ACS）危险分层的关联性。方法 将71例患者根据ACS诊断标准分为UAP组、NSTEMI组和STEMI组；根据GRACE标准对患者进行危险评分并计算院内以及出院6个月时死亡以及死亡/心梗风险；按GRACE评分标准将各组患者分为低危、中危、高危三组；对不同分组及不同危险分层进行比较。结果 71例ACS患者，UAP 22例（31%），其中低危组10例，中危组9例，高危组3例；NSTEMI 17例（24%），其中低危组3例，中危组7例，高危组7例；STEMI 32例（45%），其中低危组4例，中危组18例，高危组10例。根据危险分层，UAP与NSTEMI各组间的院内死亡危险积分和院内死亡率的差异有统计学意义(P＜0.05)；STEMI组的院内死亡率在低高危组、中高危组间差异有统计学意义(P＜0.01)，但低中危组间差异无统计学意义(P＞0.05)；院内死亡危险积分在不同分层间差异有统计学意义(P＜0.01)；H-FABP和UA在三组各自的分层间差异无统计学意义(P＞0.05)；而IMA在NSTMEI组危险分层的低高危、中高危组间差异有统计学意义(P＜0.01)，在其余两组的各自分层间差异无统计学意义(P＞0.05)；UAP、NSTEMI和STEMI的低危组、中危组和高危组比较，院内死亡率、H-FABP、IMA、UA均无统计学意义（P＞0.05）；而UAP、NSTEMI和STEMI的高危组比较，院内死亡危险积分在UAP与STEMI组间差异有统计学意义（P＜0.05）。结论 院内死亡率、院内死亡危险积分是进行危险分层的有效指标，根据危险分层可初步判断患者病情，指导临床治疗。但H-FABP、IMA、UA的检查结果尚不能作为判断病情的指标来指导临床。

Abstract: Objective To explore the correlation of risk stratification of acute coronary syndrome（ACS）with ischemia modified albumin (IMA), heart fatty acid binding protein (H-FABP) and uric acid. Methods 70 patients were divided into unstable angina pectoris (UAP), ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI) group based on ACS standard. They were divided into low-risk, Intermediate-risk and high-risk groups based on GRACE risk score. Results 22 (31%) patients were admitted for UAP, 17 (24%) for NSTEMI, and 32 (45%) for STEMI. There were significantly difference in hospital mortality risk score and hospital mortality between UAP and NSTMEI groups (P＜0.05). The hospital mortality in STEMI group had significantly difference between low and high-risk group (P＜0.05). There were no significantly difference for serum H-FABP and UA levels in three groups (P>0.05). The serum IMA had clearly difference between low and high-risk group in NSTMEI (P＜0.01). Conclusion Hospital mortality risk score and hospital mortality play an important role in GRACE to indicate the disease severity. The serum H-FABP, IMA and UA levels cannot be considered as the indexes to judge the degree of ACS.