目的  评价缺血修饰白蛋白(ischemia-modified albumin，IMA)对慢性肾脏病(chronic kidney disease，CKD)3～5 期患者主要不良心血管事件(major adverse cardiovascular events，MACE)的预测价值。方法研究对象为慢性肾脏病3～5 期未行肾脏替代治疗的患者213 例，平均年龄(41.77±11.21)岁；收集患者基础资料、IMA 及各项实验室指标，并对相关指标进行分析。结果依据血清IMA 水平将CKD 患者分为2 组：正常IMA 组[(IMA＜85kU/L，159 例，(77.12±10.43)kU/L]；高IMA 组[IMA≥85kU/L，54 例，(90.33±12.20)kU/L]。至随访结束时，高IMA 组患者MACE 发生19 例，发生率为35.19%，远较正常IMA 组高(33 例，发生率20.75%；χ2=4.549，P=0.033)。logistic 回归分析显示IMA(OR1.104，95% CI 1.033～1.178，P=0.028)、超敏C 反应蛋白(OR 1.232，95% CI 1.109～1.342，P=0.001)是CKD 患者重要的心血管事件独立危险因素。生存分析显示高IMA 组CKD 患者无心血管事件生存率较正常IMA 组低(Log-rank 检验χ2=15.830，P＜0.001)。结论IMA 升高的CKD 患者MACE 发生率较高，IMA 是CKD 患者重要的心血管事件独立危险因素，IMA可做为慢性肾脏病患者主要不良心血管事件的预测指标。

Objective The aim of this study was to evaluate the efficiency of ischemia-modified albumin (IMA) for predicting major adverse cardiovascular events (MACE) in chronic kidney disease (CKD) patients. Methods A total of 222 CKD patients were enrolled in this study. Baseline characteristics, IMA level and other laboratory measurements were collected and analyzed. The primary end point was the occurrence of MACE. Results A total of 213 participants finally completed this study, and 9 CKD patients were excluded because of dialysis treatment. They were divided into normal IMA group (IMA <85 KU/L, n=159, average IMA=77.12±10.43 KU/L) and high IMA group (IMA >85 KU/L, n=54, average IMA=90.33±12.20 KU/L). At the end of follow-up, the prevalence of MACE was 20.75% (33 cases) in normal IMA group and was 35.19% (19 cases) in high IMA group (χ2=4.549, P=0.033). Logistic regression analysis showed that IMA (OR=1.104, 95% CI 1.033 ~1.178; P=0.028) and hs-CRP (OR=1.232, 95% CI 1.109~1.342; P=0.001) were the independent risk factors for MACE in CKD patients. Kaplan-Meier survival analysis showed that the CKD patients with higher IMA level had lower non-MACE survival rate (Log-rank test, χ2=15.830, P＜0.001), indicating that the CKD patients with higher IMA level have higher prevalence of MACE. Conclusions CKD patients with higher IMA level had higher prevalence of MACE. IMA was the independent risk factors for MACE. Therefore, IMA may be a predictive marker for MACE in CKD patients.