van Domburg R T, Cobbaert C, Müller-Bardorff M, Kampmann M, Kimman G P, Rauscher T, Schoolmann S, Zerback R, Katus H A, Simoons M L
Thoraxcenter, University Hospital Rotterdam Dijkzigt, The Netherlands.
Scand J Clin Lab Invest. 2000 Dec;60(8):665-75. doi: 10.1080/00365510050216394.
In a prospective trial, the diagnostic performance of the second version of the troponin T rapid assay (Trop T; cutoff 0.2 microg/L) was compared with the quantitative cardiac-specific troponin T assay (cTnT ELISA; cutoff 0.1 microg/L) and other established cardiac markers such as CK, CK-MB activity, CK-MB mass and myoglobin. Additionally, a 30-day follow-up was performed to determine the suitability of the Trop T assay and the reference markers for short-term risk stratification. Two-hundred-and-eighty-six consecutive patients with chest pain and suspected acute myocardial infarction (AMI) were enrolled in two CCU departments. Serial blood specimens were taken at admission and at 3, 6, 12, 24, 48, 72 and 96 h after admission. According to the biochemical criterion CK-MB mass, the patients were classified as having AMI in 154 patients (54%), unstable angina (UAP) in 72 patients (27%) and no evidence for acute cardiac ischemia in 55 patients (19%). Analytical method comparison of Trop T with cTnT ELISA (cutoff 0.1 microg/L) showed a good agreement, Trop T yielded only 4% false-negative and 3% false-positive results. The diagnostic performance of Trop T for the detection of AMI was only slightly inferior compared to cTnT ELISA. Beyond 12 h after admission, Trop T and cTnT ELISA maintained a sensitivity close to 100%, whereas the sensitivity of the other cardiac markers decreased sharply. The diagnostic sensitivity of Trop T for the detection of minor myocardial damage in UAP patients was the same as for cTnT ELISA. Death within 30 days' follow-up occurred only in AMI patients with a positive Trop T test result within the first 6 h after admission. The admission Trop T and cTnT ELISA were the only significant biochemical predictors of major cardiac events. In conclusion, these data show that Trop T has similar diagnostic sensitivity as cTnT ELISA and is a useful tool to confirm acute or subacute myocardial infarction. Trop T is an excellent marker in detecting minor myocardial damage in UAP patients and is suitable for short-term risk stratification.
在一项前瞻性试验中，将第二代肌钙蛋白T快速检测法（肌钙蛋白T；临界值0.2微克/升）的诊断性能与定量心肌特异性肌钙蛋白T检测法（cTnT ELISA；临界值0.1微克/升）以及其他已确立的心脏标志物（如肌酸激酶、CK-MB活性、CK-MB质量和肌红蛋白）进行了比较。此外，进行了为期30天的随访，以确定肌钙蛋白T检测法和参考标志物用于短期风险分层的适用性。两个冠心病监护病房连续纳入了286例胸痛且疑似急性心肌梗死（AMI）的患者。在入院时以及入院后3、6、12、24、48、72和96小时采集系列血标本。根据生化标准CK-MB质量，154例患者（54%）被分类为患有AMI，72例患者（27%）为不稳定型心绞痛（UAP），55例患者（19%）无急性心脏缺血证据。肌钙蛋白T与cTnT ELISA（临界值0.1微克/升）的分析方法比较显示一致性良好，肌钙蛋白T产生的假阴性结果仅为4%，假阳性结果为3%。肌钙蛋白T检测AMI的诊断性能与cTnT ELISA相比仅略逊一筹。入院12小时后，肌钙蛋白T和cTnT ELISA的敏感性维持在接近100%，而其他心脏标志物的敏感性则急剧下降。肌钙蛋白T检测UAP患者轻微心肌损伤的诊断敏感性与cTnT ELISA相同。30天随访期间的死亡仅发生在入院后6小时内肌钙蛋白T检测结果为阳性的AMI患者中。入院时的肌钙蛋白T和cTnT ELISA是主要心脏事件的唯一显著生化预测指标。总之，这些数据表明肌钙蛋白T具有与cTnT ELISA相似的诊断敏感性，是确认急性或亚急性心肌梗死的有用工具。肌钙蛋白T是检测UAP患者轻微心肌损伤的优秀标志物，适用于短期风险分层。
