Strømme J H, Rolstad O J, Mangschau A
Klinisk kjemisk avdeling, Laboratoriemedisinsk divisjon, Oslo.
Tidsskr Nor Laegeforen. 2000 Jun 20;120(16):1863-9.
During the last ten years new, more sensitive and specific cardiac markers in blood for detection of acute myocardial injuries have been characterised and clinically evaluated. Of practical importance is also the fact that rapid and robust methods and equipments suitable for emergency service have been developed.
Based on literature study and on own experiences we give a survey of the most promising cardiac markers with emphasis on the troponin T and troponin I.
Methodological and pathobiochemical aspects are discussed. The diagnostic characteristics and advantages of the new markers are in focus, especially with respect to early detection of acute myocardial injuries. Finally, we discuss their potential use for stratification of patients with acute coronary syndromes with respect to optimal treatment, resource-saving monitoring, and more precise prognostication.
It is recommended that one of the troponins, either I or T, should be included in the diagnostic regime for detecting acute coronary syndromes in Norwegian hospitals. CKMB, determined as mass and not as activity, ought to be retained, at least until more clinical experience with the troponins have been gained by the hospital. Myoglobin may only be of interest if early exclusion of myocardial injuries has practical consequences. In this connection the transaminases and LDH are no longer of any interest.
在过去十年中，已对用于检测急性心肌损伤的血液中新型、更敏感且特异的心脏标志物进行了鉴定和临床评估。同样具有实际重要性的是，已开发出适用于急诊服务的快速且可靠的方法和设备。
基于文献研究和自身经验，我们对最有前景的心脏标志物进行了综述，重点关注肌钙蛋白T和肌钙蛋白I。
讨论了方法学和病理生物化学方面的内容。新标志物的诊断特征和优势是重点，特别是在急性心肌损伤的早期检测方面。最后，我们讨论了它们在急性冠状动脉综合征患者分层中的潜在用途，涉及最佳治疗、资源节约型监测和更精确的预后评估。
建议挪威医院在检测急性冠状动脉综合征的诊断方案中纳入肌钙蛋白I或T其中之一。肌酸激酶同工酶（CKMB）应以质量而非活性来测定，并且至少应保留至医院获得更多关于肌钙蛋白的临床经验。如果早期排除心肌损伤具有实际意义，肌红蛋白可能才会受到关注。就此而言，转氨酶和乳酸脱氢酶已不再具有任何意义。
