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非急性冠脉综合征的非心脏疾病和心脏疾病中血清心肌肌钙蛋白I水平的升高

Elevation of serum cardiac troponin I in noncardiac and cardiac diseases other than acute coronary syndromes.

作者信息

Khan I A, Tun A, Wattanasauwan N, Win M T, Hla T A, Hussain A, Vasavada B C, Sacchi T J

机构信息

Department of Medicine, Long Island College Hospital, Brooklyn, NY, USA.

出版信息

Am J Emerg Med. 1999 May;17(3):225-9. doi: 10.1016/s0735-6757(99)90110-9.

Abstract

This study evaluated the role of serum cardiac troponin I as a biochemical marker for the diagnosis of acute coronary syndromes in the presence of noncardiac diseases. Diagnostic characteristics were examined in 102 consecutive patients who were found to have serum cardiac troponin I levels higher than the upper reference limit of 0.6 ng/mL. Of 102 patients with cardiac troponin I levels of >0.6 ng/mL, 35 did not have the final diagnoses of acute coronary syndromes (myocardial infarction or unstable angina) but had various other final diagnoses, including nonischemic dilated cardiomyopathy, muscular disorders, central nervous system disorders, HIV disease, chronic renal failure, sepsis, lung diseases, and endocrine disorders. The mean value of serum cardiac troponin I in the patients with diseases other than acute coronary syndromes was significantly lesser than in those with acute coronary syndromes (2.0+/-1.9 [SD] v. 24.7+/-28.2 ng/mL; P<.0001). There were significantly fewer histories of chest pain and prior myocardial infarction in patients with diseases other than acute coronary syndromes than in those with acute coronary syndromes (history of chest pain, 3 v. 48 patients [P<.001]; history of prior myocardial infarction, 0 v. 30 patients [P<.001]). In conclusion, elevated serum levels of cardiac troponin I, especially in the lower ranges, should be interpreted with caution, particularly in patients suffering from acute illnesses who lack other diagnostic features suggestive of acute coronary ischemic events.

摘要

本研究评估了血清心肌肌钙蛋白I在存在非心脏疾病时作为急性冠状动脉综合征诊断生化标志物的作用。对102例连续患者进行了诊断特征检查,这些患者的血清心肌肌钙蛋白I水平高于0.6 ng/mL的参考上限。在102例心肌肌钙蛋白I水平>0.6 ng/mL的患者中,35例最终诊断并非急性冠状动脉综合征(心肌梗死或不稳定型心绞痛),而是患有各种其他最终诊断疾病,包括非缺血性扩张型心肌病、肌肉疾病、中枢神经系统疾病、HIV疾病、慢性肾衰竭、败血症、肺部疾病和内分泌疾病。非急性冠状动脉综合征患者的血清心肌肌钙蛋白I平均值显著低于急性冠状动脉综合征患者(2.0±1.9[标准差]对24.7±28.2 ng/mL;P<0.0001)。非急性冠状动脉综合征患者的胸痛病史和既往心肌梗死病史明显少于急性冠状动脉综合征患者(胸痛病史,3例对48例患者[P<0.001];既往心肌梗死病史,0例对30例患者[P<0.001])。总之,如果血清心肌肌钙蛋白I水平升高,尤其是处于较低水平时,应谨慎解读,特别是对于患有急性疾病且缺乏其他提示急性冠状动脉缺血事件诊断特征的患者。

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