Background: Ischemia-modified albumin (IMA) is an altered type of serum albumin that forms under conditions of oxidative stress and an independent predictor of major adverse cardiovascular events.

Objectives: To measure the levels of IMA in 45 children and adolescents with β-thalassemia major (β-TM) compared with 30 healthy controls and assess its relation to lipid peroxidation, vascular complications and subclinical atherosclerosis.

Methods: β-TM patients without symptoms of heart disease were studied focusing on transfusion history, chelation therapy, serum ferritin, malondialdehyde (MDA) and IMA levels. Echocardiography was performed and carotid intima media thickness (CIMT) was assessed.

Results: IMA and MDA levels were significantly higher in β-TM patients compared with controls (p < 0.001). IMA was higher among patients with heart disease, pulmonary hypertension risk and serum ferritin ≥2500 µg/l than those without. TM patients compliant to chelation had significantly lower IMA levels. IMA levels were positively correlated to MDA and CIMT while negatively correlated to ejection fraction and fractional shortening.

Conclusion: Our results highlight the role of oxidative stress in the pathophysiology of vascular complications in thalassemia. IMA could be useful for screening of β-TM patients at risk of cardiopulmonary complications and atherosclerosis because its alteration occurs in early subclinical disease.

背景：缺血修饰白蛋白（IMA）是一种改变类型的血清白蛋白，在氧化应激条件下形成，是主要不良心血管事件的独立预测因子。

目的：测量 45 名重型 β 地中海贫血 (β-TM) 儿童和青少年与 30 名健康对照者的 IMA 水平，并评估其与脂质过氧化、血管并发症和亚临床动脉粥样硬化的关系。

方法：对无心脏病症状的 β-TM 患者进行研究，重点关注输血史、螯合治疗、血清铁蛋白、丙二醛 (MDA) 和 IMA 水平。进行超声心动图检查并评估颈动脉内膜中层厚度（CIMT）。

结果：与对照组相比，β-TM 患者的 IMA 和 MDA 水平显着升高 ( p < 0.001)。患有心脏病、肺动脉高压风险和血清铁蛋白≥2500 µg/l 的患者的 IMA 高于没有心脏病的患者。接受螯合治疗的 TM 患者 IMA 水平显着降低。 IMA水平与MDA和CIMT呈正相关，而与射血分数和缩短分数呈负相关。

结论：我们的结果强调了氧化应激在地中海贫血血管并发症的病理生理学中的作用。 IMA 可用于筛查有心肺并发症和动脉粥样硬化风险的 β-TM 患者，因为其改变发生在早期亚临床疾病中。