Rolstad O J, Strømme J H, Mangschau A
Hjerte-lunge-senteret, Ullevål sykehus 0407 Oslo.
Tidsskr Nor Laegeforen. 2001 Feb 10;121(4):415-20.
New cardiac markers that may be analysed around the clock in emergency can now be performed in our hospitals with commercially available reagents and equipment. Upon the introduction of a new clinical biochemical regime based on these new markers for the diagnosis of acute coronary syndromes, we evaluated the clinical benefit achieved by the new set-up, especially with respect to early diagnosis.
cTroponinT, CK-MBmass, myoglobin and total-CKactivity were analysed in blood sample taken on admission, after 2-3 hours, and further once or twice over the next 24 hours in 300 patients admitted on suspicion of acute coronary syndromes (ACS). The study was based on results of the cardiac markers and information given on questionnaires by the physicians in charge.
With the decision limits applied, CK-MB and myoglobin showed slightly higher sensitivity than cTroponinT for detecting acute myocardial infarction within the first 2-3 hours. cTroponinT showed the highest sensitivity for detecting heart muscle damage in patients with unstable angina. cTroponinT was the most cardiospecific marker. If the patient was considered not having ACS after the first few hours, only 3% ended with a diagnose of unstable angina and none with acute myocardial infarction. Of those considered certain ACS cases after the first few hours, 92% ended up with the diagnosis acute myocardial infarction or unstable angina. Treatment and/or supervision were changed in 68 of 220 patients based on the results of the two first blood samples, 85% of them to a lower level of supervision.
cTroponinT and CK-MB are useful markers for early detection of acute myocardial injuries. A prerequisite is that they are determined in two samples with an interval of at least two hours. In this case, myoglobin did not give additional information. Based on the results from two early blood samples, about one quarter of the patients could immediately be transferred to a less expensive level of care.
现在，我们医院可以使用市售试剂和设备随时对新的心脏标志物进行紧急分析。在引入基于这些新标志物的用于诊断急性冠状动脉综合征的新临床生化方案后，我们评估了新方案所带来的临床益处，尤其是在早期诊断方面。
对300例疑似急性冠状动脉综合征（ACS）的患者入院时、2 - 3小时后以及接下来24小时内再进行一到两次采集的血样进行肌钙蛋白T、肌酸激酶同工酶质量、肌红蛋白和总肌酸激酶活性分析。该研究基于心脏标志物的检测结果以及负责医生在问卷中提供的信息。
在所应用的判定界限下，肌酸激酶同工酶和肌红蛋白在最初2 - 3小时内检测急性心肌梗死的敏感性略高于肌钙蛋白T。肌钙蛋白T在检测不稳定型心绞痛患者的心肌损伤方面敏感性最高。肌钙蛋白T是最具心脏特异性的标志物。如果患者在最初几小时后被认为没有急性冠状动脉综合征，最终只有3%被诊断为不稳定型心绞痛，无一例被诊断为急性心肌梗死。在最初几小时后被认为是确诊急性冠状动脉综合征的患者中，92%最终被诊断为急性心肌梗死或不稳定型心绞痛。根据前两份血样的结果，220例患者中有68例的治疗和/或监护级别发生了改变，其中85%降至较低的监护级别。
肌钙蛋白T和肌酸激酶同工酶是早期检测急性心肌损伤的有用标志物。前提是在间隔至少两小时的两个样本中进行测定。在这种情况下，肌红蛋白并未提供额外信息。根据两份早期血样的结果，约四分之一的患者可立即转至费用较低的护理级别。
